Predictors and clinical outcomes of poor symptomatic improvement after transcatheter aortic valve replacement

Nobuhiro Yoshijima, Tetsuya Saito, Taku Inohara, Atsushi Anzai, Hikaru Tsuruta, Hideyuki Shimizu, Keiichi Fukuda, Toru Naganuma, Kazuki Mizutani, Masahiro Yamawaki, Norio Tada, Futoshi Yamanaka, Shinichi Shirai, Minoru Tabata, Hiroshi Ueno, Kensuke Takagi, Yusuke Watanabe, Masanori Yamamoto, Kentaro Hayashida

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Objective Transcatheter aortic valve replacement (TAVR) improves clinical symptoms in most patients with severe aortic stenosis (AS). However, some patients do not benefit from the symptom-reducing effects of TAVR. We assessed the predictors and clinical outcomes of poor symptomatic improvement (SI) after TAVR. Methods A total of 1749 patients with severe symptomatic AS undergoing transfemoral TAVR were evaluated using the Japanese multicentre TAVR registry. Poor SI was defined as readmission for heart failure (HF) within 1 year after TAVR or New York Heart Association (NYHA) class ≥3 after 1 year. A logistic regression model was used to identify predictors of poor SI. One-year landmark analysis after TAVR was used to evaluate the association between poor SI and clinical outcomes. Results Among the overall population (mean age, 84.5 years; female, 71.3%; mean STS score, 6.3%), 6.6% were categorised as having poor SI. Atrial fibrillation, chronic obstructive pulmonary disease, Clinical Frailty Scale ≥4, chronic kidney disease and moderate to severe mitral regurgitation were independent predictors of poor SI. One-year landmark analysis demonstrated that poor SI had a higher incidence of all-cause death and readmission for HF compared with SI (p<0.001). Poor SI with preprocedural NYHA class 2 had a worse outcome than SI with preprocedural NYHA class ≥3. Conclusions Poor SI was associated with worse outcomes 1 year after the procedure. It had a greater impact on clinical outcomes than baseline symptoms. TAVR may be challenging for patients with many predictors of poor SI. Trial registration number This registry, associated with the University Hospital Medical Information Network Clinical Trials Registry, was accepted by the International Committee of Medical Journal Editors (UMIN-ID: 000020423).

Original languageEnglish
Article numbere001742
JournalOpen Heart
Volume8
Issue number2
DOIs
Publication statusPublished - 2021 Nov 22

Keywords

  • aortic valve stenosis
  • heart failure
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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