Outcome of patients with heart failure after transcatheter aortic valve implantation

• Published in: PloS one 2019-11, Vol.14 (11), p.e0225473-e0225473
• Main Authors: Fischer-Rasokat, Ulrich, Renker, Matthias, Liebetrau, Christoph, Weferling, Maren, Rolf, Andreas, Doss, Mirko, Möllmann, Helge, Walther, Thomas, Hamm, Christian W, Kim, Won-Keun
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aorta; Aortic stenosis; Aortic valve; Aortic valve stenosis; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - therapy; Biology and Life Sciences; Body Mass Index; Cardiac patients; Cardiology; Cardiovascular diseases; Comparative analysis; Congestive heart failure; Disease control; Echocardiography; Female; Heart diseases; Heart failure; Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - mortality; Heart surgery; Heart valve diseases; Humans; Implantation; Kaplan-Meier Estimate; Male; Medical diagnosis; Medical prognosis; Medicine and Health Sciences; Mortality; Patient outcomes; Patients; Prognosis; Proportional Hazards Models; Pulmonary Disease, Chronic Obstructive - complications; Retrospective Studies; Rheumatic heart disease; Risk groups; Signs and symptoms; Stenosis; Stroke; Stroke Volume; Surface area; Systematic review; Transcatheter Aortic Valve Replacement
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0225473

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. 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 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. 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.