Aortic Stenosis Staging Shows Correlation with Mortality Following TAVR

A new study suggests a relationship between aortic stenosis staging and mortality following transcatheter aortic valve replacement (TAVR).

Researchers for the cohort analysis enrolled 689 consecutive patients with severe aortic stenosis who underwent TAVR. They then collected clinical, laboratorial, and procedural data from the Society of Thoracic Surgeons database. The authors, seeking to test a recently proposed aortic stenosis staging system based on echocardiographic markers of abnormal cardiac function, classified the patients into four stages:

• stage 1: Left ventricle changes (increased left ventricular mass index; early mitral inflow to early diastolic mitral annulus velocity (E/e′) >14; and left ventricular ejection fraction <50%)
• stage 2: Left atrial or mitral change (left atrial volume index >34 mL/m²; moderate to severe mitral regurgitation; and atrial fibrillation)
• stage 3: Pulmonary artery or tricuspid changes (pulmonary artery systolic pressure ≥60 mm Hg; moderate to severe tricuspid regurgitation)
• stage 4: Right ventricle changes; moderate to severe right ventricle dysfunction

The primary study outcome was post-TAVR all-cause mortality, with secondary outcomes including composites of all-cause mortality and post-TAVR readmissions.

Evaluation of the extent of cardiac changes might improve #patientcare, risk stratification, assessment of prognosis, and shared decision making for patients in need of #TAVR https://t.co/8ByLLAFrXQ

— JAMA Cardiology (@JAMACardio) February 6, 2019

The prevalence of stage 1 was 13%; stage 2, 62%; stage 3, 21%; and stage 4, 4%, according to the study results. Higher staging was associated with a greater burden of comorbidities. A graded association between aortic stenosis staging and mortality was observed [stage 2 versus stage 1 (P=0.25); stage 3 versus stage 1 (P=0.005); and stage 4 versus stage 1 (P=0.004). Patients in stage 3 had higher post-TAVR cardiac (P=0.01) and noncardiac readmission rates.

So proud of this incredible work led by Dr @Miho_Fukui_ and @PittCardiology! We validate AS staging proposed by @philgenereux and show, for the 1st time, that extent of cardiac damage also associates w/ cardiac and non-cardiac readmissions post-TAVR. @bonowr @MHIF_Heart @PPibarot https://t.co/tpmOcTw1wQ

— João Cavalcante (@JoaoLCavalcante) February 6, 2019

“Aortic stenosis staging appears to show a strong graded association between the extent of cardiac changes and post-TAVR all-cause mortality,” the researchers wrote. “Such staging may improve patient care, risk stratification, assessment of prognosis, and shared decision making for patients undergoing TAVR.”

MHIF Researchers @Miho_Fukui_ and Dr. @JoaoLCavalcante published in @JAMACardio today! He notes that these findings "…emphasize the importance to identify upfront patients who might need a closer follow-up and additional therapies beyond #TAVR ." https://t.co/H0kxQgM6aB

— Minneapolis Heart Institute Foundation (@MHIF_Heart) February 7, 2019

The study was published in JAMA Cardiology.

Source: JAMA Cardiology