Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement
Abstract Aims There is evidence to suggest that the subtype of aortic stenosis (AS), the degree of myocardial fibrosis (MF), and level of aortic valve calcification (AVC) are associated with adverse cardiac outcome in AS. Because little is known about their respective contribution, we sought to inve...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-08-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14307 |
| _version_ | 1827891557001330688 |
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| author | Ruben Evertz Sebastian Hub Bo Eric Beuthner Sören J. Backhaus Torben Lange Alexander Schulz Karl Toischer Tim Seidler Stephan vonHaehling Miriam Puls Johannes T. Kowallick Elisabeth M. Zeisberg Gerd Hasenfuß Andreas Schuster |
| author_facet | Ruben Evertz Sebastian Hub Bo Eric Beuthner Sören J. Backhaus Torben Lange Alexander Schulz Karl Toischer Tim Seidler Stephan vonHaehling Miriam Puls Johannes T. Kowallick Elisabeth M. Zeisberg Gerd Hasenfuß Andreas Schuster |
| author_sort | Ruben Evertz |
| collection | DOAJ |
| description | Abstract Aims There is evidence to suggest that the subtype of aortic stenosis (AS), the degree of myocardial fibrosis (MF), and level of aortic valve calcification (AVC) are associated with adverse cardiac outcome in AS. Because little is known about their respective contribution, we sought to investigate their relative importance and interplay as well as their association with adverse cardiac events following transcatheter aortic valve replacement (TAVR). Methods and results One hundred consecutive patients with severe AS and indication for TAVR were prospectively enrolled between January 2017 and October 2018. Patients underwent transthoracic echocardiography, multidetector computed tomography, and left ventricular endomyocardial biopsies at the time of TAVR. The final study cohort consisted of 92 patients with a completed study protocol, 39 (42.4%) of whom showed a normal ejection fraction (EF) high‐gradient (NEFHG) AS, 13 (14.1%) a low EF high‐gradient (LEFHG) AS, 25 (27.2%) a low EF low‐gradient (LEFLG) AS, and 15 (16.3%) a paradoxical low‐flow, low‐gradient (PLFLG) AS. The high‐gradient phenotypes (NEFHG and LEFHG) showed the largest amount of AVC (807 ± 421 and 813 ± 281 mm3, respectively) as compared with the low‐gradient phenotypes (LEFLG and PLFLG; 503 ± 326 and 555 ± 594 mm3, respectively, P < 0.05). Conversely, MF was most prevalent in low‐output phenotypes (LEFLG > LEFHG > PLFLG > NEFHG, P < 0.05). This was paralleled by a greater cardiovascular (CV) mortality within 600 days after TAVR (LEFLG 28% > PLFLG 26.7% > LEFHG 15.4% > NEFHG 2.5%; P = 0.023). In patients with a high MF burden, a higher AVC was associated with a lower mortality following TAVR (P = 0.045, hazard ratio 0.261, 95% confidence interval 0.07–0.97). Conclusions MF is associated with adverse CV outcome following TAVR, which is most prevalent in low EF situations. In the presence of large MF burden, patients with large AVC have better outcome following TAVR. Conversely, worse outcome in large MF and relatively little AVC may be explained by a relative prominence of an underlying cardiomyopathy. The better survival rates in large AVC patients following TAVR indicate TAVR induced relief of severe AS‐associated pressure overload with subsequently improved outcome. |
| first_indexed | 2024-03-12T21:26:25Z |
| format | Article |
| id | doaj.art-4c95eeb43843471cb1003f427872ebb6 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-12T21:26:25Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-4c95eeb43843471cb1003f427872ebb62023-07-28T06:30:48ZengWileyESC Heart Failure2055-58222023-08-011042307231810.1002/ehf2.14307Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacementRuben Evertz0Sebastian Hub1Bo Eric Beuthner2Sören J. Backhaus3Torben Lange4Alexander Schulz5Karl Toischer6Tim Seidler7Stephan vonHaehling8Miriam Puls9Johannes T. Kowallick10Elisabeth M. Zeisberg11Gerd Hasenfuß12Andreas Schuster13Department of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Diagnostic and Interventional Radiology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyDepartment of Cardiology and Pneumology University Medical Center Göttingen (UMG), Georg August University of Göttingen Göttingen GermanyAbstract Aims There is evidence to suggest that the subtype of aortic stenosis (AS), the degree of myocardial fibrosis (MF), and level of aortic valve calcification (AVC) are associated with adverse cardiac outcome in AS. Because little is known about their respective contribution, we sought to investigate their relative importance and interplay as well as their association with adverse cardiac events following transcatheter aortic valve replacement (TAVR). Methods and results One hundred consecutive patients with severe AS and indication for TAVR were prospectively enrolled between January 2017 and October 2018. Patients underwent transthoracic echocardiography, multidetector computed tomography, and left ventricular endomyocardial biopsies at the time of TAVR. The final study cohort consisted of 92 patients with a completed study protocol, 39 (42.4%) of whom showed a normal ejection fraction (EF) high‐gradient (NEFHG) AS, 13 (14.1%) a low EF high‐gradient (LEFHG) AS, 25 (27.2%) a low EF low‐gradient (LEFLG) AS, and 15 (16.3%) a paradoxical low‐flow, low‐gradient (PLFLG) AS. The high‐gradient phenotypes (NEFHG and LEFHG) showed the largest amount of AVC (807 ± 421 and 813 ± 281 mm3, respectively) as compared with the low‐gradient phenotypes (LEFLG and PLFLG; 503 ± 326 and 555 ± 594 mm3, respectively, P < 0.05). Conversely, MF was most prevalent in low‐output phenotypes (LEFLG > LEFHG > PLFLG > NEFHG, P < 0.05). This was paralleled by a greater cardiovascular (CV) mortality within 600 days after TAVR (LEFLG 28% > PLFLG 26.7% > LEFHG 15.4% > NEFHG 2.5%; P = 0.023). In patients with a high MF burden, a higher AVC was associated with a lower mortality following TAVR (P = 0.045, hazard ratio 0.261, 95% confidence interval 0.07–0.97). Conclusions MF is associated with adverse CV outcome following TAVR, which is most prevalent in low EF situations. In the presence of large MF burden, patients with large AVC have better outcome following TAVR. Conversely, worse outcome in large MF and relatively little AVC may be explained by a relative prominence of an underlying cardiomyopathy. The better survival rates in large AVC patients following TAVR indicate TAVR induced relief of severe AS‐associated pressure overload with subsequently improved outcome.https://doi.org/10.1002/ehf2.14307Aortic valve calcificationMyocardial fibrosisTranscatheter aortic valve replacement |
| spellingShingle | Ruben Evertz Sebastian Hub Bo Eric Beuthner Sören J. Backhaus Torben Lange Alexander Schulz Karl Toischer Tim Seidler Stephan vonHaehling Miriam Puls Johannes T. Kowallick Elisabeth M. Zeisberg Gerd Hasenfuß Andreas Schuster Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement ESC Heart Failure Aortic valve calcification Myocardial fibrosis Transcatheter aortic valve replacement |
| title | Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement |
| title_full | Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement |
| title_fullStr | Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement |
| title_full_unstemmed | Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement |
| title_short | Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement |
| title_sort | aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement |
| topic | Aortic valve calcification Myocardial fibrosis Transcatheter aortic valve replacement |
| url | https://doi.org/10.1002/ehf2.14307 |
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