Key result
Updated cardiac damage staging stratifies post-TAVR 1-year mortality from 0% up to ~20%.
Why the study?
Does the updated cardiac damage classification incorporating the echocardiographic probability of pulmonary hypertension stratify 1-year all-cause mortality in patients with symptomatic severe aortic stenosis undergoing transcatheter aortic valve replacement?
RCT (n=596)
randomized to the Myval transcatheter heart valve (THV) series or to contemporary THVs (Sapien and Evolut series)
Does the updated cardiac damage classification incorporating the echocardiographic probability of pulmonary hypertension stratify 1-year all-cause mortality in patients with symptomatic severe aortic stenosis undergoing transcatheter aortic valve replacement?
Updated cardiac damage staging incorporating echocardiographic probability of pulmonary hypertension effectively stratifies 1-year mortality risk after TAVR, with stage 4 right ventricular damage and cumulative damage carrying the highest mortality.
Answers are grounded in this paper and cite their sources.
Updated staging with PH probability refines AS risk stratification post-TAVR; leaves open prospective validation before guiding management.
BACKGROUND: The extent of cardiac damage in patients with aortic stenosis (AS) is associated with worse clinical outcomes. OBJECTIVES: This study sought to investigate the clinical impact of cardiac damage using the updated criteria incorporating the echocardiographic probability of pulmonary hypertension. METHODS: This post hoc subanalysis of LANDMARK trial, which randomized 768 patients with severe AS to the Myval transcatheter heart valve (THV) series or to contemporary THVs (Sapien and Evolut series), used updated cardiac damage classification: stage 0, no cardiac damage; stage 1, left ventricular damage; stage 2, left atrial or mitral valve damage; stage 3, pulmonary artery or tricuspid valve damage; and stage 4, right ventricular damage. The impact of cumulative cardiac damage, defined as meeting all criteria for stages 1 to 4, was also assessed. The primary endpoint was 1-year all-cause mortality. RESULTS: Cardiac damage stages were assessed in 596 patients (stage 0, n = 36; stage 1, n = 88; stage 2, n = 284; stage 3, n = 84; stage 4, n = 104), with a mean age of 80.2 (5.7) years and a mean Society of Thoracic Surgeons score of 3.3% (2.4%). One-year mortality was 0%, 1.1%, 4.7%, 7.2%, and 20.4% in stages 0, 1, 2, 3, and 4, respectively (log-rank P < 0.001). The area under the curve for predicting 1-year mortality was 0.739. Patients with cumulative cardiac damage had the highest mortality (23.6%). In the multivariable analysis, stage 4 was independently associated with higher 1-year mortality. CONCLUSIONS: The updated cardiac damage staging stratified 1-year mortality after transcatheter aortic valve replacement, highlighting the importance of comprehensive echocardiographic assessment in severe AS. (LANDMARK Trial: a Randomised Controlled Trial of Myval THV [LANDMARK]; NCT04275726).
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Tobe et al. (2026) conducted an RCT in Symptomatic severe aortic stenosis undergoing transcatheter aortic valve replacement (n=596). Updated cardiac damage classification (stages 1 to 4 and cumulative cardiac damage) vs. Stage 0 (no cardiac damage) or lower cardiac damage stages was evaluated on 1-year all-cause mortality (p=< 0.001). Updated cardiac damage staging (stages 0-4) stratified 1-year mortality after TAVR from 0% in stage 0 to 20.4% in stage 4 (log-rank P<0.001; AUC 0.739).
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