Outcome of patients with heart failure after transcatheter aortic valve implantation

Fischer‐Rasokat, Ulrich; Renker, Matthias; Liebetrau, Christoph; Weferling, Maren; Rolf, Andreas; Doss, Mirko; Möllmann, Helge; Walther, Thomas; Hamm, Christian W.; Kim, Won-Keun

doi:10.1371/journal.pone.0225473

Cited by 17 publications

(18 citation statements)

References 36 publications

(39 reference statements)

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“…The impact of an event of worsening HF prior to TAVI on short-and mid-term outcomes after TAVI, including future hospitalizations for HF, was demonstrated in a recent analysis of the Placement of Aortic Transcatheter Valves (PARTNER) 2 trial and registries (19). These results, together with abundant previous data (4,(20)(21)(22), confirm the hypothesis that concomitant, established HF persists in certain patients with AS, even after restoration of aortic valve function by TAVI. In our study, it was even more surprising to see the parallel prognostic impacts of high PVS (immediately before TAVI) and the existence of PCD, since the definition of PCD in our study was not restricted to a particular time period before TAVI.…”

Section: Discussionmentioning

confidence: 53%

“…Worsening of heart failure (HF) is the most common reason for readmission after transcatheter aortic valve implantation (TAVI), and rates of re-hospitalization for HF range from 16% at 30 days (1) to 24% at one year (2) post-TAVI, reducing the positive overall costbenefit relationship of TAVI procedures in certain patient population (3). Moreover, patients with severe aortic stenosis (AS) and concomitant systolic HF continue to have severely limited outcomes after TAVI (4), indicating that persisting left ventricular impairment drives prognosis even after correction of afterload. Worsening of HF marks a crossroads in the course of HF.…”

Section: Introductionmentioning

confidence: 99%

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Predictive value of overt and non-overt volume overload in patients with high- or low-gradient aortic stenosis undergoing transcatheter aortic valve implantation

Fischer‐Rasokat¹,

Renker²,

Liebetrau³

et al. 2021

Cardiovasc Diagn Ther

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Background: The plasma volume status (PVS) is considered a marker of non-overt cardiac congestion and is of prognostic value. Patients with low-flow, low-gradient (LFLG) aortic stenosis (AS) suffer from impaired left ventricular function and show signs of heart failure (HF). We hypothesized that PVS might predict postinterventional rehospitalization and cardiovascular mortality in high-risk patients undergoing transcatheter aortic valve implantation (TAVI).Methods: In this retrospective, observational analysis, PVS before transfemoral TAVI was calculated by a formula taking into account hematocrit and weight. The predictive performance of PVS was compared with that of prior cardiac decompensation (PCD).Results: In the entire cohort of n=2,458 patients, PVS >−4% (high plasma volume) identified patients (n=1,013) with a higher post-interventional 1-year mortality rate than patients (n=1,445) with a PVS ≤−4% (low plasma volume). However, PVS lost prognostic independence when adjusted for anemia, whereas PCD did not. A high PVS and PCD were not correlated, and both parameters similarly revealed a low sensitivity and specificity but a high negative predictive value (NPV) for future HF events. PVS was not different between control patients (n=1,512) and those with intermediate (paradoxical LFLG-AS, n=327) or high risk scores (LFLG-AS, n=239). The accuracy of high PVS in predicting adverse events in these subpopulations was the same as in the study population overall. Kaplan-Maier analyses demonstrated similar prognostic impacts for PVS and PCD.Conclusions: PVS and PCD represent two independent parameters of volume overload with unfavorable prognostic significance. Pre-interventional PVS does not appear to be suitable for predicting clinical outcomes in high-risk patients undergoing TAVI.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Predictive value of overt and non-overt volume overload in patients with high- or low-gradient aortic stenosis undergoing transcatheter aortic valve implantation

Fischer‐Rasokat¹,

Renker²,

Liebetrau³

et al. 2021

Cardiovasc Diagn Ther

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“…While the reported prevalence of HF of ischemic, idiopathic, or valvular etiology in patients with AS undergoing TAVI varies widely-from 10-40% based on the definition of HF [10]-there is unanimous agreement on the negative prognostic impact of HF in patients with AS after TAVI. [2][3][4]11,12]. Therefore, one can speculate that ICD implantation in addition to medical HF therapy could save lives in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Certain patients undergoing transcatheter aortic valve implantation (TAVI) for severe, symptomatic aortic stenosis (AS) may fulfill these criteria. Supporting arguments for the indication of ICD therapy in these patients include clinical and laboratory characteristics like those of HF patients [2] together with a high rate of prior cardiac decompensation, [3,4] persistent structural and functional impairment of the LV after correction of AS, [5,6] and a postinterventional course comparable to that of typical HF patients characterized by a high rate of hospitalization and poor survival [3,4,7]. Such patients are diagnosed with concomitant HF and should be treated by guideline-directed therapies.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Survival in Patients with or without Implantable Cardioverter Defibrillator after Transcatheter Aortic Valve Implantation

Fischer‐Rasokat

Renker

Liebetrau

et al. 2021

JCM

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Patients with symptomatic aortic stenosis (AS) can have concomitant systolic heart failure (HF) that persists even after correction of afterload by transcatheter aortic valve implantation (TAVI). These patients qualify as potential candidates for prophylactic therapy with an implantable cardioverter defibrillator (ICD). We compared survival between patients with or without an ICD after successful TAVI. This retrospective study analyzed Kaplan-Meier survival data during a follow-up period of three years in two populations: (a) patients with a left ventricular ejection fraction (LVEF) ≤ 35% before TAVI (overall population); (b) patients with additionally documented LVEF ≤ 35% 3 months after TAVI (persistent LV dysfunction subpopulation). In the overall population, 53 patients with and 193 patients without an ICD had similar baseline characteristics and procedural success rates, and HF medication at discharge was comparable. Three-year mortality rates were 26.4% for patients with an ICD and 24.4% for patients without an ICD (p = 0.758). Cardiovascular death rates were similar between groups (p = 0.914), and deaths were most often attributed to worsening of HF. Survival rates in patients with persistent LV dysfunction with an ICD (n = 24) or without an ICD (n = 59) were similar between groups (p = 0.872), with cardiovascular deaths mostly qualified as worsening HF and none as sudden cardiac death. Patients of the overall study population with biventricular pacing devices showed only a tendency to have better outcomes (p = 0.298). ICD therapy in elderly patients with AS and LV dysfunction undergoing TAVI did not demonstrate a survival benefit during a 3-year follow-up period.

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“…Patients with AS who develop HF have suboptimal outcomes after TAVR or SAVR compared to their non‐HF counterparts 3–5 . Acute HF at presentation in TAVR or SAVR candidates is associated with even worse prognosis despite correction of AS 2,6,7 .…”

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Transcatheter aortic valve replacement after heart failure hospitalization: too little, too late?

Parikh

Tsigkas

Kalogeropoulos

2020

European J of Heart Fail

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This article refers to 'Impact of recent heart failure hospitalization on clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: an analysis from the PARTNER 2 trial and registries' by S. Chen et al., published in this issue on pages 1866-1874. Among adults with severe aortic stenosis (AS) who are scheduled to undergo surgical (SAVR) or transcatheter aortic valve replacement (TAVR), a substantial proportion is hospitalized with heart failure (HF) in the weeks preceding the procedure. 1,2 In Ontario, Canada, 12% of patients referred for TAVR were hospitalized for HF within a median of 80 days wait time. 1 Similarly, in the FinnValve registry, 11% of patients waiting for TAVR or SAVR developed acute HF within 60 days prior to the procedure. 2 Patients with AS who develop HF have suboptimal outcomes after TAVR or SAVR compared to their non-HF counterparts. 3-5 Acute HF at presentation in TAVR or SAVR candidates is associated with even worse prognosis despite correction of AS. 2,6,7 In the FinnValve registry, recent acute HF was associated with lower 30-day and 5-year survival, more post-procedural complications (including acute renal failure), and higher rates of healthcare resource utilization in both the SAVR and TAVR groups. 2 Similarly, in a retrospective cohort from France, TAVR recipients presenting with acute HF had more post-procedural acute renal failure and requirement for inotropic support, and significantly higher mortality both at 30 days (10% vs. 5%, P = 0.02) and at 1 year (27% vs. 15%, P < 0.001) compared to stable patients. 7 Importantly, acute HF was widely prevalent (>50%) in patients with AS on the TAVR waitlist who were untreated. 7 This finding is consistent with contemporary reports of high rates of hospitalization for HF among untreated patients with AS. 8 In this issue of the Journal, Chen and colleagues provide additional insights into the impact of acute HF on the clinical outcomes of intermediate-to-high or prohibitive surgical risk patients undergoing TAVR for severe symptomatic AS. 9 The investigators The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.

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Outcome of patients with heart failure after transcatheter aortic valve implantation

Cited by 17 publications

References 36 publications

Predictive value of overt and non-overt volume overload in patients with high- or low-gradient aortic stenosis undergoing transcatheter aortic valve implantation

Predictive value of overt and non-overt volume overload in patients with high- or low-gradient aortic stenosis undergoing transcatheter aortic valve implantation

Long-Term Survival in Patients with or without Implantable Cardioverter Defibrillator after Transcatheter Aortic Valve Implantation

Transcatheter aortic valve replacement after heart failure hospitalization: too little, too late?

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