Key result
The presence of cardiohepatic syndrome in patients undergoing TAVR for severe aortic stenosis was associated with significantly worse three-year survival (HR 1.58) compared to normal hepatic function.
Why the study?
Cardiohepatic syndrome is an underrecognized survival predictor in cardiovascular diseases, but its prevalence and prognostic value in patients undergoing TAVR for severe aortic stenosis were unclear.
Does the presence of cardiohepatic syndrome worsen survival and clinical outcomes in patients undergoing TAVR for severe aortic stenosis?
Cohort (n=953)
No
Does the presence of cardiohepatic syndrome worsen survival and clinical outcomes in patients undergoing TAVR for severe aortic stenosis?
Hazard Ratio: 1.58 (95% CI 1.122–2.225)
Absolute Event Rate: 49.4% vs 65.4%
p-value: p=0.009
Cardiohepatic syndrome is present in over 20% of patients undergoing TAVR and serves as an independent predictor of increased 3-year mortality.
CHS independently predicts higher post-TAVR mortality; hypothesis-generating for cardiohepatic risk modification in prospective studies.
BACKGROUND: Cardiohepatic syndrome (CHS) has been identified as an important but underrecognized survival predictor in multiple cardiovascular disease entities. The objectives of this study were to evaluate the prevalence and prognostic value of CHS in patients undergoing TAVR for severe aortic stenosis (AS). METHODS: The study included patients with available laboratory parameters of hepatic function who underwent TAVR from July 2013 until December 2019 at our center. CHS was defined as an elevation of at least two of three laboratory cholestasis parameters above the upper limit of normal (bilirubin, alkaline phosphatase, and gamma glutamyl transferase). Study endpoints were three-year survival, technical and device failure (VARC 3), as well as New York Heart Association (NYHA) functional class at follow-up. RESULTS: Among a total of 953 analyzed patients (47.6% females, median age 80.0 [76.0-85.0] years) CHS was present in 212 patients (22.4%). In patients with vs. without CHS, rates of technical (6.1% vs. 8.4%, p = 0.29) and device failure (18.9% vs. 17.3%, p = 0.59) were comparable. NYHA functional class at baseline and follow-up was more severe in patients with CHS. Nevertheless, heart failure symptoms improved from baseline to follow-up irrespective of hepatic function. Three-year survival rates were significantly lower in patients with CHS (49.4 vs. 65.4%, p < 0.001). The predictive value of CHS persisted after adjustment in a multivariable analysis (hazard ratio 1.58, p < 0.01). CONCLUSION: In patients undergoing TAVR, CHS is prevalent in 22% of patients and is associated with increased postinterventional mortality. Thus, CHS should be included in the decision-making process within the TAVR heart team. Cardiohepatic syndrome (CHS) as defined by an elevation of at least two of three laboratory cholestasis parameters above the upper limit of normal was prevalent in 22% of patients undergoing TAVR for severe AS. The presence of CHS was associated with more severe heart failure symptoms and worse three-year survival.
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Stolz et al. (2023) conducted a cohort in Severe symptomatic aortic stenosis (n=953). Cardiohepatic syndrome (CHS) vs. No cardiohepatic syndrome was evaluated on Three-year survival (HR 1.58, 95% CI 1.122-2.225, p=0.009). The presence of cardiohepatic syndrome in patients undergoing TAVR for severe aortic stenosis was associated with significantly worse three-year survival (HR 1.58) compared to normal hepatic function.
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