Outcome of patients with heart failure after transcatheter aortic valve implantation


Autoři: Ulrich Fischer-Rasokat aff001;  Matthias Renker aff001;  Christoph Liebetrau aff001;  Maren Weferling aff001;  Andreas Rolf aff001;  Mirko Doss aff003;  Helge Möllmann aff005;  Thomas Walther aff003;  Christian W. Hamm aff001;  Won-Keun Kim aff001
Působiště autorů: Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany aff001;  Department of Cardiology and Angiology, Medical Clinic I, University Hospital of Giessen, Giessen, Germany aff002;  Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany aff003;  German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany aff004;  Department of Cardiology, Medical Clinic I, St. Johannes Hospital, Dortmund, Germany aff005;  Department of Cardiac, Thoracic and Thoracic Vascular Surgery, University Hospital of the Goethe University, Frankfurt/Main, Germany aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225473

Souhrn

Aims

Patients with aortic stenosis (AS) may have concomitant heart failure (HF) that determines prognosis despite successful transcatheter aortic valve implantation (TAVI). We compared outcomes of TAVI patients with low stroke volume index (SVI) ≤35 ml/m2 body surface area in different HF classes.

Methods and results

Patients treated by transfemoral TAVI at our center (n = 1822) were classified as 1) ‘HF with preserved ejection fraction (EF)’ (HFpEF, EF ≥50%), 2) ‘HF with mid-range EF’ (HFmrEF, EF 40–49%), or 3) ‘HF with reduced EF’ (HFrEF, EF <40%). Patients with SVI >35 ml/m2 served as controls. The prevalence of cardiovascular disease and symptoms increased stepwise from controls (n = 968) to patients with HFpEF (n = 591), HFmrEF (n = 97), and HFrEF (n = 166). Mortality tended to be highest in HFrEF patients 30 days post-procedure, and it became significant after one year: 10.2% (controls), 13.5% (HFpEF), 13.4% (HFmrEF), and 23.5% (HFrEF). However, symptomatic improvement in survivors of all groups was achieved in the majority of patients without differences among groups.

Conclusions

Patients with AS and HF benefit from TAVI with respect to symptom alleviation. TAVI in patients with HFpEF and HFmrEF led to an identical, favorable post-procedural prognosis that was significantly better than that of patients with HFrEF, which remains a high-risk population.

Klíčová slova:

Aortic valve – Blood pressure – Body Mass Index – Death rates – Ejection fraction – Heart failure – Chronic obstructive pulmonary disease – Prognosis


Zdroje

1. Lauten A, Figulla HR, Mollmann H, Holzhey D, Kotting J, Beckmann A, et al. TAVI for low-flow, low-gradient severe aortic stenosis with preserved or reduced ejection fraction: a subgroup analysis from the German Aortic Valve Registry (GARY). EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2014;10(7):850–9.

2. Ribeiro HB, Lerakis S, Gilard M, Cavalcante JL, Makkar R, Herrmann HC, et al. Transcatheter Aortic Valve Replacement in Patients With Low-Flow, Low-Gradient Aortic Stenosis: The TOPAS-TAVI Registry. J Am Coll Cardiol. 2018;71(12):1297–308. doi: 10.1016/j.jacc.2018.01.054 29566812

3. Rodriguez-Gabella T, Nombela-Franco L, Auffret V, Asmarats L, Islas F, Maes F, et al. Transcatheter Aortic Valve Implantation in Patients With Paradoxical Low-Flow, Low-Gradient Aortic Stenosis. Am J Cardiol. 2018;122(4):625–32. doi: 10.1016/j.amjcard.2018.04.044 30064863

4. Luo X, Zhao Z, Chai H, Zhang C, Liao Y, Li Q, et al. Efficacy of transcatheter aortic valve implantation in patients with aortic stenosis and reduced LVEF. A systematic review. Herz. 2015;40 Suppl 2:168–80.

5. Eleid MF, Goel K, Murad MH, Erwin PJ, Suri RM, Greason KL, et al. Meta-Analysis of the Prognostic Impact of Stroke Volume, Gradient, and Ejection Fraction After Transcatheter Aortic Valve Implantation. Am J Cardiol. 2015;116(6):989–94. doi: 10.1016/j.amjcard.2015.06.027 26195275

6. Amabile N, Agostini H, Gilard M, Eltchaninoff H, Iung B, Donzeau-Gouge P, et al. Impact of low preprocedural transvalvular gradient on cardiovascular mortality following TAVI: an analysis from the FRANCE 2 registry. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2014;10(7):842–9.

7. Conrotto F, D'Ascenzo F, D'Amico M, Moretti C, Pavani M, Scacciatella P, et al. Outcomes of patients with low-pressure aortic gradient undergoing transcatheter aortic valve implantation: A Meta-analysis. Catheter Cardiovasc Interv. 2017;89(6):1100–6. doi: 10.1002/ccd.26839 27862874

8. Puls M, Korte KP, Bleckmann A, Huenlich M, Danner BC, Schoendube F, et al. Long-term outcomes after TAVI in patients with different types of aortic stenosis: the conundrum of low flow, low gradient and low ejection fraction. EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2017;13(3):286–93.

9. Voros G, Ector J, Garweg C, Droogne W, Van Cleemput J, Peersman N, et al. Increased Cardiac Uptake of Ketone Bodies and Free Fatty Acids in Human Heart Failure and Hypertrophic Left Ventricular Remodeling. Circulation Heart failure. 2018;11(12):e004953. doi: 10.1161/CIRCHEARTFAILURE.118.004953 30562098

10. Gotzmann M, Hauptmann S, Hogeweg M, Choudhury DS, Schiedat F, Dietrich JW, et al. Hemodynamics of paradoxical severe aortic stenosis: insight from a pressure-volume loop analysis. Clin Res Cardiol. 2019.

11. Beach JM, Mihaljevic T, Rajeswaran J, Marwick T, Edwards ST, Nowicki ER, et al. Ventricular hypertrophy and left atrial dilatation persist and are associated with reduced survival after valve replacement for aortic stenosis. J Thorac Cardiovasc Surg. 2014;147(1):362–9 e8. doi: 10.1016/j.jtcvs.2012.12.016 23312984

12. Liebetrau C, Gaede L, Kim WK, Arsalan M, Blumenstein JM, Fischer-Rasokat U, et al. Early changes in N-terminal pro-B-type natriuretic peptide levels after transcatheter aortic valve replacement and its impact on long-term mortality. Int J Cardiol. 2018;265:40–6. doi: 10.1016/j.ijcard.2018.02.037 29885699

13. Ribeiro HB, Urena M, Le Ven F, Nombela-Franco L, Allende R, Clavel MA, et al. Long-term prognostic value and serial changes of plasma N-terminal prohormone B-type natriuretic peptide in patients undergoing transcatheter aortic valve implantation. Am J Cardiol. 2014;113(5):851–9. doi: 10.1016/j.amjcard.2013.11.038 24528616

14. Steiner J, Rodes-Cabau J, Holmes DR Jr., LeWinter MM, Dauerman HL. Mechanical Intervention for Aortic Valve Stenosis in Patients With Heart Failure and Reduced Ejection Fraction. J Am Coll Cardiol. 2017;70(24):3026–41. doi: 10.1016/j.jacc.2017.10.040 29241492

15. Pibarot P, Messika-Zeitoun D, Ben-Yehuda O, Hahn RT, Burwash IG, Van Mieghem NM, et al. Moderate Aortic Stenosis and Heart Failure With Reduced Ejection Fraction: Can Imaging Guide Us to Therapy? JACC Cardiovascular imaging. 2019;12(1):172–84. doi: 10.1016/j.jcmg.2018.10.021 30621989

16. Schmidt T, Bohne M, Schluter M, Kitamura M, Wohlmuth P, Schewel D, et al. The impact of biventricular heart failure on outcomes after transcatheter aortic valve implantation. Clin Res Cardiol. 2018.

17. Kaneko H, Hoelschermann F, Tambor G, Okamoto M, Neuss M, Butter C. Impact of N-terminal pro-B-type natriuretic peptide response on long-term prognosis after transcatheter aortic valve implantation for severe aortic stenosis and heart failure. Heart and vessels. 2018.

18. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–91. doi: 10.1093/eurheartj/ehx391 28886619

19. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European heart journal cardiovascular Imaging. 2015;16(3):233–70.

20. Clavel MA, Messika-Zeitoun D, Pibarot P, Aggarwal SR, Malouf J, Araoz PA, et al. The complex nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study. J Am Coll Cardiol. 2013;62(24):2329–38. doi: 10.1016/j.jacc.2013.08.1621 24076528

21. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure. 2016;18(8):891–975. doi: 10.1002/ejhf.592 27207191

22. Spitzer E, Van Mieghem NM, Pibarot P, Hahn RT, Kodali S, Maurer MS, et al. Rationale and design of the Transcatheter Aortic Valve Replacement to UNload the Left ventricle in patients with ADvanced heart failure (TAVR UNLOAD) trial. Am Heart J. 2016;182:80–8. doi: 10.1016/j.ahj.2016.08.009 27914503

23. Koh AS, Tay WT, Teng THK, Vedin O, Benson L, Dahlstrom U, et al. A comprehensive population-based characterization of heart failure with mid-range ejection fraction. European journal of heart failure. 2017;19(12):1624–34. doi: 10.1002/ejhf.945 28948683

24. Bhambhani V, Kizer JR, Lima JAC, van der Harst P, Bahrami H, Nayor M, et al. Predictors and outcomes of heart failure with mid-range ejection fraction. European journal of heart failure. 2018;20(4):651–9. doi: 10.1002/ejhf.1091 29226491

25. Lauritsen J, Gustafsson F, Abdulla J. Characteristics and long-term prognosis of patients with heart failure and mid-range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta-analysis. ESC heart failure. 2018;5(4):685–94. doi: 10.1002/ehf2.12283 29660263

26. Altaie S, Khalife W. The prognosis of mid-range ejection fraction heart failure: a systematic review and meta-analysis. ESC heart failure. 2018;5(6):1008–16. doi: 10.1002/ehf2.12353 30211480

27. Nauta JF, Hummel YM, van Melle JP, van der Meer P, Lam CSP, Ponikowski P, et al. What have we learned about heart failure with mid-range ejection fraction one year after its introduction? European journal of heart failure. 2017;19(12):1569–73. doi: 10.1002/ejhf.1058 29067761

28. Tschope C, Birner C, Bohm M, Bruder O, Frantz S, Luchner A, et al. Heart failure with preserved ejection fraction: current management and future strategies: Expert opinion on the behalf of the Nucleus of the "Heart Failure Working Group" of the German Society of Cardiology (DKG). Clin Res Cardiol. 2018;107(1):1–19. doi: 10.1007/s00392-017-1170-6 29018938

29. Investigators S, Yusuf S, Pitt B, Davis CE, Hood WB, Cohn JN. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325(5):293–302. doi: 10.1056/NEJM199108013250501 2057034

30. Rodriguez-Gabella T, Catala P, Munoz-Garcia AJ, Nombela-Franco L, Del Valle R, Gutierrez E, et al. Renin-Angiotensin System Inhibition Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2019;74(5):631–41. doi: 10.1016/j.jacc.2019.05.055 31370954

31. Arsalan M, Filardo G, Kim WK, Squiers JJ, Pollock B, Liebetrau C, et al. Prognostic value of body mass index and body surface area on clinical outcomes after transcatheter aortic valve implantation. Clin Res Cardiol. 2016;105(12):1042–8. doi: 10.1007/s00392-016-1027-4 27535139

32. de Miguel Diez J, Chancafe Morgan J, Jimenez Garcia R. The association between COPD and heart failure risk: a review. Int J Chron Obstruct Pulmon Dis. 2013;8:305–12. doi: 10.2147/COPD.S31236 23847414

33. Guazzi M. Pulmonary Hypertension and Heart Failure: A Dangerous Liaison. Heart Fail Clin. 2018;14(3):297–309. doi: 10.1016/j.hfc.2018.02.006 29966628


Článek vyšel v časopise

PLOS One


2019 Číslo 11