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Nuche J, Ternacle J, Avvedimento M, Cheema AN, Veiga-Fernández G, Muñoz-García AJ, Vilalta V, Regueiro A, Asmarats L, Del Trigo M, Serra V, Bonnet G, Jonveaux M, Esposito G, Rezaei E, de la Torre-Hernández JM, Fernández-Nofrerías E, Vidal P, Gutiérrez-Alonso L, Oteo JF, Belahnech Y, Mohammadi S, Philippon F, Modine T, Mesnier J, Rodés-Cabau J. Incidence, predictors, and prognostic significance of impaired functional status early after transcatheter aortic valve replacement. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:396-407. [PMID: 38000627 DOI: 10.1016/j.rec.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION AND OBJECTIVES There are scarce data on the factors associated with impaired functional status after transcatheter aortic valve replacement (TAVR) and its clinical impact. This study aimed to determine the incidence, predictors, and prognostic implications of impaired functional class (NYHA class III-IV) following TAVR. METHODS This multicenter study included 3462 transarterial TAVR patients receiving newer generation devices. The patients were compared according to their NYHA class at 1 month of follow-up (NYHA I-II vs NYHA III-IV). A multivariate logistic regression was performed to identify the predictors of 30-day NYHA class III-IV. Patient survival was compared with the Kaplan-Meier method and factors associated with decreased survival were identified with Cox regression analysis. RESULTS The mean age of the study population was 80.3±7.3 years, with 47% of women, and a median Society of Thoracic Surgeons score of 3.8% [IQR, 2.5-5.8]. A total of 208 patients (6%) were in NYHA class III-IV 1 month after TAVR. Predictors of 30-day NYHA class III-IV were baseline NYHA class III-IV (OR, 1.76; 95%CI, 1.08-2.89; P=.02), chronic pulmonary obstructive disease (OR, 1.80; 95%CI, 1.13-2.83; P=.01), and post-TAVR severe mitral regurgitation (OR, 2.00; 95%CI, 1.21-3.31; P<.01). Patients in NYHA class III-IV 1 month after TAVR were at higher risk of death (HR, 3.68; 95%CI, 2.39-5.70; P<.01) and heart failure-related hospitalization (HR, 6.00; 95%CI, 3.76-9.60; P<.01) at 1-year follow-up. CONCLUSIONS Up to 6% of contemporary TAVR patients exhibited an impaired functional status following TAVR. Worse baseline NYHA class, chronic pulmonary obstructive disease, and severe mitral regurgitation predicted 30-day NYHA class III/IV, and this determined a higher risk of mortality and heart failure hospitalization at 1-year follow-up. Further studies on the prevention and treatment optimization of patients with impaired functional status after TAVR are needed.
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Affiliation(s)
- Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. https://twitter.com/@JorgeNuche
| | - Julien Ternacle
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France. https://twitter.com/@TernacleJ
| | - Marisa Avvedimento
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. https://twitter.com/@MAvvedimento
| | - Asim N Cheema
- Cardiology Department, St Michael's Hospital Toronto, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Gabriela Veiga-Fernández
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Insituto de Investigación Valdecilla, Santander, Spain. https://twitter.com/@gveigafernandez
| | - Antonio J Muñoz-García
- Servicio de Cardiología, Hospital Regional Universitario Virgen de la Victoria, Málaga, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Victoria Vilalta
- Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain. https://twitter.com/@victoria_vilalta
| | - Ander Regueiro
- Servicio de Cardiología, Hospital Clínic Barcelona, Barcelona, Spain. https://twitter.com/@AnderRegueiro
| | - Luis Asmarats
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. https://twitter.com/@AsmaratsL
| | - María Del Trigo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. https://twitter.com/@MaridaDelTrigo
| | - Vicenç Serra
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Guillaume Bonnet
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France. https://twitter.com/@guilbon
| | - Melchior Jonveaux
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Effat Rezaei
- Cardiology Department, St Michael's Hospital Toronto, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - José M de la Torre-Hernández
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Insituto de Investigación Valdecilla, Santander, Spain
| | | | - Pablo Vidal
- Servicio de Cardiología, Hospital Clínic Barcelona, Barcelona, Spain. https://twitter.com/@pvidalcales
| | | | - Juan Francisco Oteo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Yassin Belahnech
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Thomas Modine
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. https://twitter.com/@JulesMesnier
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Servicio de Cardiología, Hospital Clínic Barcelona, Barcelona, Spain.
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