What is the clinical evidence from this study?

Study design: Observational. Population: Severe symptomatic aortic valve stenosis (n=1703). Intervention: Eccentric hypertrophy (EH) pattern vs. Other hypertrophy patterns (Normal geometry, Concentric remodeling, Concentric hypertrophy). Primary outcome: 1-year all-cause mortality (p=0.001).

December 9, 2024Open Access

Eccentric hypertrophy impairs outcome after TAVR

Key Result

Eccentric hypertrophy in patients undergoing TAVR for severe aortic stenosis was associated with significantly higher 1-year all-cause mortality (17.4%) compared to other hypertrophy patterns.

Study Design

Type

Observational (n=1,703)

Multicenter

Yes

Structured PICO

Does eccentric hypertrophy impair overall survival in patients with severe symptomatic aortic stenosis undergoing TAVR compared to other hypertrophy patterns?

Population

1,703 patients with severe symptomatic aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR), mean age 80 ± 6 years, 49% male, in Germany. Categorized by left ventricular mass index and relative wall thickness into normal geometry (n=57), concentric remodeling (n=388), concentric hypertrophy (n=993), and eccentric hypertrophy (n=265).

Intervention

Transcatheter aortic valve replacement (TAVR) in patients with eccentric hypertrophy (EH)

Comparator

Transcatheter aortic valve replacement (TAVR) in patients with other left ventricular hypertrophy patterns (normal geometry, concentric remodeling, concentric hypertrophy)

Outcome

Overall survival (all-cause mortality) after the TAVR procedurehard clinical

Eccentric hypertrophy is associated with significantly worse short- and mid-term survival following TAVR compared to other left ventricular hypertrophy patterns.

Main Result

Absolute Event Rate: 17.4% vs 14%

p-value: p=0.001

Limitations

Retrospective design
Echocardiography quality is dependent on patient constitution and examiner abilities
Strain echocardiography was not performed
Very limited numbers of patients included in the normal geometry group
Mean follow-up time was limited to an average of 2.82 years
No laboratory values, such as NT-proBNP, were included in the analysis
Cardiac amyloidosis could not be included as a prognostic factor due to limited cardiac MRI data
Polygenic risk scores (PRS) calculated from European GWAS may have lower predictive performance in non-European ancestry
PRS were calculated for traits in patients suffering from cardiac hypertrophy caused by pathologies other than aortic stenosis

Abstract

BACKGROUND: Aortic stenosis (AS) induces cardiac remodeling upon chronic left ventricular (LV) pressure overload. Here, we analyzed the clinical outcome of patients undergoing transcatheter aortic valve replacement (TAVR) for symptomatic AS with regard to varying LV hypertrophy patterns. Moreover, we investigated the genetic influence on development of different hypertrophy patterns, measured by polygenic risk scores (PRS). METHODS: 1703 patients with severe AS undergoing TAVR were categorized according to LV mass index and relative wall thickness in four subgroups: normal geometry (NG, n = 57), concentric remodeling (CR; n = 388), concentric hypertrophy (CH; n = 993) and eccentric hypertrophy (EH; n = 265). Data was analyzed retrospectively with regard to clinical outcome. In a substudy, 520 patients affected by CH (n = 237), EH (n = 139) or CR (n = 164) were analyzed using two PRS that have been previously associated with hypertrophic and dilated cardiomyopathy. RESULTS: 1 year after TAVR, for EH, in contrast to the remaining groups (NG, CR, CH), a significant difference in all-cause mortality was observable (mortality 17.4% EH, 14.0% NG, 12.4% CR, 14.0% CH, p = 0.001). This difference was observed up to 4 years (mortality 41.9% EH, 26.9% CH, 28.1% CR, 26.4% NG, p = 0.001). Of note, higher percentiles in a PRS for hypertrophic cardiomyopathy were associated with a reduced likelihood of EH in patients with AS (p = 0.046). CONCLUSIONS: The EH group had a statistically significant poorer 1-year and 5-year outcomes than the other groups. PRS might help predict myocardial reactions in patients with aortic stenosis in future.

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