Regression of Left Ventricular Mass After Transcatheter Aortic Valve Replacement The PARTNER Trials and Registries

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:75

Article

Chau, Katherine H.^1,2  Douglas, Pamela S.³  Pibarot, Philippe⁴  Hahn, Rebecca T.²  Khalique, Omar K.²  Jaber, Wael A.⁵  Cremer, Paul⁵  Weissman, Neil J.⁶  Asch, Federico M.⁶  Zhang, Yiran¹  Gertz, Zachary M.⁷  Elmariah, Sammy⁸  Clavel, Marie-Annick⁴  Thourani, Vinod H.⁹  Daubert, Melissa³  Alu, Maria C.^1,2  Leon, Martin B.^1,2  Lindman, Brian R.^10,11 

[1] Cardiovasc Res Fdn, New York, NY USA

[2] Columbia Univ, New York Presbyterian Hosp, Irving Med Ctr, Struct Heart & Valve Ctr, New York, NY USA

[3] Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA

[4] Univ Laval, Inst Univ Cardiol & Pneumol Quebec, Quebec City, PQ, Canada

[5] Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44106 USA

[6] Georgetown Univ, Medstar Hlth Res Inst, Washington, DC USA

[7] Virginia Commonwealth Univ, Sch Med, Richmond, VA USA

[8] Massachusetts Gen Hosp, Boston, MA 02114 USA

[9] Piedmont Heart Inst, Marcus Heart & Vasc Ctr, Dept Cardiovasc Surg, Atlanta, GA USA

[10] Vanderbilt Univ, Med Ctr, Struct Heart & Valve Ctr, 2525 West End Ave,Suite 300-A, Nashville, TN 37203 USA

[11] Vanderbilt Univ, Med Ctr, Cardiovasc Med Div, Nashville, TN USA

关键词: aortic stenosis;    hospitalization;    left ventricular hypertrophy;    left ventricular mass regression;    mortality;    transcatheter aortic valve replacement;   

DOI  :  10.1016/j.jacc.2020.03.042

来源: Elsevier

【 摘 要 】

BACKGROUND Greater early left ventricular mass index (LVMi) regression is associated with fewer hospitalizations 1 year after transcatheter aortic valve replacement (TAVR). The association between LVMi regression and longer-term post-TAVR outcomes is unclear. OBJECTIVES The purpose of this study was to determine the association between LVMi regression at 1-year post-TAVR and clinical outcomes between 1 and 5 years. METHODS Among intermediate- and high-risk patients who received TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) I, II, and S3 trials or registries and were alive at 1 year, we included patients with baseline moderate or severe left ventricular hypertrophy (LVH) and paired measurements of LVMi at baseline and 1 year. The associations between LVMi regression (percent change between baseline and 1 year) and death or rehospitalization from 1 to 5 years were examined. RESULTS Among 1,434 patients, LVMi was 146 g/m(2) (interquartile range [IQR]: 133 to 168 g/m(2)) at baseline and decreased 14.5% (IQR: 4.2% to 26.1%) to 126 g/m(2) (IQR: 106 to 148 g/m(2)) at 1 year. After adjustment, greater LVMi regression at 1 year was associated with lower all-cause death (adjusted hazard ratio [aHR]: 0.95 per 10% decrease in LVMi; 95% confidence interval [CI]: 0.91 to 0.98; p = 0.004; aHR of the quartile with greatest vs. least LVMi regression: 0.61; 95% CI: 0.43 to 0.86; p = 0.005). Severe LVH at 1 year was observed in 39%, which was independently associated with increased all-cause death (aHR of severe LVH vs. no LVH: 1.71; 95% CI: 1.20 to 2.44; p = 0.003). Similar associations were found for rates of cardiovascular mortality and rehospitalization. CONCLUSIONS Among patients with moderate or severe LVH treated with TAVR who are alive at 1 year, greater LVMi regression at 1 year is associated with lower death and hospitalization rates to 5 years. These findings may have implications for the timing of valve replacement and the role of adjunctive medical therapy after TAVR. (J Am Coll Cardiol 2020;75:2446-58) (c) 2020 by the American College of Cardiology Foundation.

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