Key result
Each extra-cardiac dysfunction domain post-TAVI predicts ~71% higher risk of HF hospitalization or death.
Why the study?
Despite diagnostic advancements, many aortic stenosis patients are diagnosed late with advanced heart failure, prompting the assessment of multiorgan dysfunction and quantitative fluid levels on clinical outcomes post-TAVI.
Does multiorgan dysfunction and fluid overload predict heart failure hospitalization or death in patients with severe aortic stenosis undergoing TAVI?
Cohort (n=880)
Does multiorgan dysfunction and fluid overload predict heart failure hospitalization or death in patients with severe aortic stenosis undergoing TAVI?
Pre-procedural multiorgan dysfunction and fluid overload are highly prevalent in severe aortic stenosis and strongly predict adverse outcomes post-TAVI.
Answers are grounded in this paper and cite their sources.
May identify higher-risk post-TAVI patients; leaves open whether targeting multiorgan dysfunction improves outcomes.
Background: Degenerative severe aortic stenosis (AS) is treated by valve replacement to improve outcome. Despite diagnostic advancements, many AS patients are still diagnosed late with advanced heart failure. Objectives: The aim of the study was to assess multiorgan dysfunction in severe AS using blood biomarkers and their association with quantitative fluid levels and clinical outcomes after transcatheter aortic valve implantation (TAVI). Methods: Consecutive AS patients undergoing TAVI received comprehensive preinterventional assessment with serum biomarker profiles reflecting organ dysfunction and quantitative fluid overload (FO) using bioelectrical impedance spectroscopy. FO by bioelectrical impedance spectroscopy was defined according to a previously established cut-off (≥1.0 L). Time to first heart failure hospitalization or death served as composite primary endpoint. Results: Among 880 patients (age 81 ± 7 years, 47% female), 41% had FO and 89% had biomarker abnormalities of at least one domain. Ascending fluid levels were independently associated with distorted biomarkers across domains of myocyte stress, hepatic dysfunction, renal dysfunction, inflammation, and anemia. After 2.4 ± 1.0 years of follow-up, 27% had reached the primary endpoint (29 heart failure hospitalization, 194 deaths, 13 both). Biomarkers across all domains were individually and independently associated with outcomes. In a multidomain approach, every affected extra-cardiac domain was associated with a 71% increase in event hazard (adjusted HR: 1.71; 95% CI: 1.39-2.11). Also, for each domain, the combination of distorted biomarkers and FO had the highest event risk. Conclusions: Biomarker abnormalities are highly prevalent in severe AS, influenced by congestion, and associated with impaired prognosis post-TAVI. Multiorgan dysfunction faces a particularly dismal outcome.
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Halavina et al. (2025) conducted a cohort in severe aortic stenosis (n=880). Transcatheter aortic valve implantation (TAVI) was evaluated on Time to first heart failure hospitalization or death (HR 1.71, 95% CI 1.39-2.11). Every affected extra-cardiac domain of multiorgan dysfunction post-TAVI increased the hazard of heart failure hospitalization or death by 71%.
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