Cardiac Damage and Quality of Life After Aortic Valve Replacement in the PARTNER Trials |
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| Institution: | 1. Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA;2. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA;3. St. Francis Hospital and Heart Center, Roslyn, New York, USA;4. Department of Medicine, Laval University, Quebec City, Quebec, Canada;5. Columbia University Irving Medical Center, New York, New York, USA;6. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden;7. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands;8. Edwards Lifesciences, Irvine, California, USA;9. Cedars Sinai Medical Center, Los Angeles, California, USA;10. Cleveland Clinic, Cleveland, Ohio, USA;11. Piedmont Heart Institute, Atlanta, Georgia, USA;12. Baylor Scott & White Research Institute, Plano, Texas, USA;13. Vanderbilt University Medical Center, Nashville, Tennessee, USA;14. Emory University School of Medicine, Atlanta, Georgia, USA;15. Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA;p. University of Washington, Seattle, Washington, USA;q. St Paul’s Hospital, Vancouver, British Columbia, Canada;r. Saint Luke''s Mid America Heart Institute, Kansas City, Missouri, USA;s. University of Missouri Kansas City, Kansas City, Missouri, USA |
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| Abstract: | BackgroundThe extent of extravalvular cardiac damage is associated with increased risk of adverse events among patients with severe aortic stenosis undergoing aortic valve replacement (AVR).ObjectivesThe goal was to describe the association of cardiac damage on health status before and after AVR.MethodsPatients from the PARTNER (Placement of Aortic Transcatheter Valves) 2 and 3 trials were pooled and classified by echocardiographic cardiac damage stage at baseline and 1 year as previously described (stage 0-4). We examined the association between baseline cardiac damage and 1-year health status (assessed by the Kansas City Cardiomyopathy Questionnaire Overall Score KCCQ-OS]).ResultsAmong 1,974 patients (794 surgical AVR, 1,180 transcatheter AVR), the extent of cardiac damage at baseline was associated with lower KCCQ scores both at baseline and at 1 year after AVR (P < 0.0001) and with increased rates of a poor outcome (death, KCCQ-OS <60, or a decrease in KCCQ-OS of ≥10 points) at 1 year (stages 0-4: 10.6% vs 19.6% vs 29.0% vs 44.7% vs 39.8%; P < 0.0001). In a multivariable model, each 1-stage increase in baseline cardiac damage was associated with a 24% increase in the odds of a poor outcome (95% CI: 9%-41%; P = 0.001). Change in stage of cardiac damage at 1 year after AVR was associated with the extent of improvement in KCCQ-OS over the same period (mean change in 1-year KCCQ-OS: improvement of ≥1 stage +26.8 95% CI: 24.2-29.4] vs no change +21.4 95% CI: 20.0-22.7] vs deterioration of ≥1 stage +17.5 95% CI: 15.4-19.5]; P < 0.0001).ConclusionsThe extent of cardiac damage before AVR has an important impact on health status outcomes, both cross-sectionally and after AVR. (PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - XT Intermediate and High Risk (PII A), NCT01314313; The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves - PII B PARTNERII B], NCT02184442; PARTNER 3 Trial: Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis P3], NCT02675114) |
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| Keywords: | aortic stenosis aortic valve replacement cardiac damage Kansas City Cardiomyopathy Questionnaire quality of life transcatheter aortic valve implantation transcatheter aortic valve replacement AVR"} {"#name":"keyword" "$":{"id":"kwrd0050"} "$$":[{"#name":"text" "_":"aortic valve replacement KCCQ-OS"} {"#name":"keyword" "$":{"id":"kwrd0060"} "$$":[{"#name":"text" "_":"Kansas City Cardiomyopathy Questionnaire Overall Score TAVR"} {"#name":"keyword" "$":{"id":"kwrd0070"} "$$":[{"#name":"text" "_":"transcatheter aortic valve replacement |
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