Cardiac damage and outcome in transcatheter aortic valve replacement patients—a COMPARE-TAVI 1 trial sub-study

AIMS: This study aims to investigate the prognostic role of Stage 3 and 4 cardiac damage (CD) after transcatheter aortic valve intervention (TAVI), dependent on whether comorbidities contributing to right heart dysfunction were present. METHODS AND RESULTS: Patients with severe aortic stenosis (AS) undergoing TAVI were included. Patients were divided into three groups: Stage 0-2 CD; Stage 3-4 CD, isolated AS (Stage 3-4 CD without significant concomitant chronic obstructive pulmonary disease, mitral annular calcification, mitral stenosis, mitral regurgitation, previous coronary artery bypass graft surgery, or cardiac amyloidosis); Stage 3-4 CD, AS with comorbidities (Stage 3-4 CD with ≥ 1 of these comorbidities). Futility was defined as death or Stage 3-4 New York Heart Association class dyspnoea 1 year after TAVI.Of 985 included patients, 822 (83%) had Stage 1-2 CD; 101 (10%) had Stage 3-4 CD, isolated AS; and 62 (6%) had Stage 3-4 CD, AS with comorbidities. Futility was not more common in Stage 3-4 CD groups (Stage 1-2 CD, 10%; Stage 3-4 CD, isolated AS, 17%; Stage 3-4 CD, AS with comorbidities, 15%, P = 0.09). Baseline and 1-year NYHA class were higher in Stage 3-4 CD compared with Stage 1-2 CD (P < 0.01). The 6 min walking test distance increased similarly in all groups at 1 year. CONCLUSION: Potential comorbidities contributing to right heart dysfunction were common among patients in Stage 3-4 CD undergoing TAVI. Stage 3-4 CD was not associated with a significantly higher risk of futility, irrespective of comorbidities, and they experienced a similar functional improvement after TAVI.