Cardiac damage extent, change at 1 year help predict post-AVR outcomes

The extent of extravalvular cardiac damage at baseline and its change at 1 year provide significant prognostic implications in patients undergoing aortic valve replacement (AVR), suggests a study.

To understand the evolution of cardiac damage post-AVR and its association with outcomes, a group of researchers pooled patients undergoing transcatheter or surgical AVR from the PARTNER 2 and 3 trials.

Participants were classified by cardiac damage stage at baseline and 1 year: stage 0, no damage; stage 1, left ventricular damage; stage 2, left atrial or mitral valve damage; stage 3, pulmonary vasculature or tricuspid valve damage; stage 4, right ventricular damage.

The researchers also used proportional hazards models to define the association between post-AVR change in cardiac damage and 2-year outcomes.

A total of 1,974 patients were enrolled, of which 121 (6.1 percent) were stage 0, 287 (14.5 percent) stage 1, 1,014 (51.4 percent) stage 2, 412 (20.9 percent) stage 3, and 140 (7.1 percent) stage 4 prior to AVR.

The extent of cardiac damage at baseline and 1 year correlated with 2-year mortality. Compared with baseline, cardiac damage improved in approximately 15 percent of patients, remained unchanged in around 60 percent, and worsened in nearly 25 percent at 1 year.

Furthermore, 1-year change in cardiac damage stage independently contributed to mortality (adjusted hazard ratio [aHR] for improvement, 0.49; aHR for no change, 1.0; aHR for worsening, 1.95; p=0.023) and to the composite of death or heart failure hospitalization (aHR for improvement, 0.60; aHR for no change, 1.0; aHR for worsening 2.25; p<0.001) at 2 years.

“These findings suggest that earlier detection of aortic stenosis and intervention prior to development of irreversible cardiac damage may improve global cardiac function and prognosis,” the researchers said.