Paradoxical prognostic impact of severe aortic stenosis following trans-catheter aortic valve implantation

Hiroshi Onoda; Teruhiko Imamura; Hiroshi Ueno; Akira Oshima; Ryuichi Ushijima; Mitsuo Sobajima; Koichiro Kinugawa

doi:10.1016/j.jjcc.2024.03.010

Paradoxical prognostic impact of severe aortic stenosis following trans-catheter aortic valve implantation

J Cardiol. 2024 Apr 4:S0914-5087(24)00056-X. doi: 10.1016/j.jjcc.2024.03.010. Online ahead of print.

Authors

Hiroshi Onoda¹, Teruhiko Imamura², Hiroshi Ueno¹, Akira Oshima¹, Ryuichi Ushijima¹, Mitsuo Sobajima¹, Koichiro Kinugawa¹

Affiliations

¹ The Second Department of Internal Medicine, University of Toyama, Toyama, Japan.
² The Second Department of Internal Medicine, University of Toyama, Toyama, Japan. Electronic address: teimamu@med.u-toyama.ac.jp.

PMID: 38580175
DOI: 10.1016/j.jjcc.2024.03.010

Abstract

Background: Aortic valve replacement is recommended for patients with "very severe" aortic stenosis (AS), irrespective of symptomatic manifestation. Nonetheless, the prognostic ramifications of "very severe" AS, as opposed to "severe" AS, subsequent to trans-catheter aortic valve implantation (TAVI) remain enigmatic.

Methods: We enrolled consecutive patients who received TAVI at our institute between May 2015 and April 2021. We scrutinized the impact of baseline "very severe" AS upon 3-year all-cause death or heart failure hospitalization following TAVI, in comparison to "severe" AS.

Results: A total of 239 patients (84.8 ± 5.4 years old, 58 men) were included. Baseline "very severe" AS was observed in 65 (27 %) patients, who exhibited more advanced hypertrophy and higher B-type natriuretic peptide levels compared to those with "severe" AS (p < 0.05 for both). Baseline "very severe" AS was paradoxically associated with higher freedom from the primary endpoint following TAVI compared to those with "severe" AS (p = 0.01).

Conclusions: The presence of baseline "very severe" AS was paradoxically associated with improved clinical outcomes subsequent to TAVI, in contrast to the cases of "severe" AS.

Keywords: Aortic stenosis; Transcatheter aortic valve implantation; Very severe aortic stenosis.