Key result
Severe pre-TAVR cardiac damage linked to ~4.8-fold higher post-procedure mortality and HF hospitalization.
Why the study?
Many elderly patients referred for TAVR do not experience symptom improvement, creating a need for new tools to better select candidates and avoid futile procedures.
Does severe echocardiographic cardiac damage staging predict all-cause mortality and heart failure hospitalizations in high-risk elderly patients with severe aortic stenosis undergoing TAVR?
Cohort (n=130)
No
Does severe echocardiographic cardiac damage staging predict all-cause mortality and heart failure hospitalizations in high-risk elderly patients with severe aortic stenosis undergoing TAVR?
Echocardiographic staging of extra-valvular cardiac damage provides a valuable prognostic tool to predict heart failure hospitalizations and mortality in elderly, high-risk patients undergoing TAVR, which may help avoid futile interventions.
Severe damage staging identifies high-risk TAVR patients; hypothesis-generating and requires prospective validation before guiding selection.
Background: A significant proportion of elderly patients referred to transcatheter aortic valve replacement (TAVR) do not experience an improvement of their symptoms. New tools are needed to better select candidates and avoid futile procedures. The objective of this study was to evaluate the impact of a new echocardiographic classification which assesses the consequences of chronic elevation of afterload on mortality and hospitalizations for heart failure (HF) in patients with severe AS undergoing TAVR. Methods: This study included 130 high-risk, elderly patients with severe AS who underwent TAVR between January 2018 and December 2019. The patients were classified into three groups according to anatomical and functional features based on transthoracic echocardiography (TTE). The combined end point was death from all causes and HF admissions. Results: Echocardiographic staging was significantly associated with increased rates of death and HF hospitalizations. After multivariate adjustment, the patients with severe cardiac damage exhibited a significant increase in hospitalizations for HF and all-cause mortality (HR 4.79; 95% CI 2.00–11.05; p = 0.000), whereas the moderate cardiac damage group did not (HR 1.84; 95% CI 0.88–3.84; p = 0.104). Conclusions: Echocardiographic staging of severe AS could be a useful tool for predicting HF hospitalizations and all-cause mortality after TAVR in elderly, high-risk patients. Evaluating cardiac damage with this new score may be a promising strategy to better select patients and improve outcomes following TAVR.
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Barcía et al. (2025) conducted a cohort in Severe Aortic Stenosis (n=130). Severe echocardiographic cardiac damage vs. Mild or moderate cardiac damage was evaluated on Composite of all-cause mortality and heart failure-related hospitalization (HR 4.79, 95% CI 2.00-11.05, p=0.000). Severe echocardiographic cardiac damage significantly increased the risk of heart failure hospitalizations and all-cause mortality after TAVR compared to lesser degrees of damage (HR 4.79, 95% CI 2.00-11.05).
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