Baseline cardiac damage predicts outcomes in patients undergoing AVR

The extent of extravalvular cardiac damage before undergoing aortic valve replacement (AVR) can predict the health status outcomes in patients cross-sectionally and after AVR, reveals a study.

Overall, 1,974 patients were included in the analysis, of whom 1,180 had transcatheter AVR and 794 surgical AVR. The extent of cardiac damage at baseline in these individuals correlated with lower Kansas City Cardiomyopathy Questionnaire Overall Score (KCCQ-OS) scores both at baseline and at 1 year after ACR (p<0.0001).

In addition, baseline cardiac damage was significantly associated with higher rates of a poor outcome (eg, death, KCCQ-OS <60, or a decrease in KCCQ-OS of ≥10 points) at 1 year (stages 0-4: 10.6 percent vs 19.6 percent vs 29.0 percent vs 44.7 percent vs 39.7 percent; p<0.0001). Multivariable analysis revealed that each 1-stage increase in baseline cardiac damage resulted in a 24-percent increase in the possibility of a poor outcome (95 percent confidence interval [CI], 9‒41; p=0.001).

Change in cardiac damage stage at 1 year following AVR showed an interaction with the extent of improvement in KCCQ-OS over the same period (improvement of ≥1 stage vs no change vs deterioration of ≥1 stage: mean change in 1-year KCCQ-OS, 26.8 [95 percent CI, 24.2‒29.4] vs 21.4 [95 percent CI, 20.0‒22.7] vs 17.5 [95 percent CI, 15.4‒19.5]; p<0.0001).

In this study, the research team pooled patients from the PARTNER* 2 and 3 trials and classified them by echocardiographic cardiac damage stage at baseline and 1 year as previously described (stage 0-4). They then explored the interaction between baseline cardiac damage and 1-year health status, as assessed by the KCCQ-OS.

*Placement of Aortic Transcatheter Valves