Evolution and prognostic implications of cardiac damage in women after transcatheter aortic valve implantation

TL;DR

This study examines how heart damage changes in women after a heart valve procedure and how these changes affect their survival outcomes.

Contribution

The study provides new insights into the prognostic value of cardiac damage staging in women after TAVI, a procedure with limited data in this population.

Findings

TAVI improved cardiac damage in 43% of women at 6-month follow-up.

Higher baseline and follow-up cardiac damage stages were independently linked to increased mortality.

Reassessing cardiac damage at 6 months added prognostic value beyond initial assessment.

Abstract

Recently, a cardiac damage staging system has been proposed in patients with severe AS to improve risk stratification, but there is still paucity of data in women. Accordingly, we aimed to characterize the change in cardiac damage after transcatheter aortic valve implantation (TAVI), and to assess the prognostic value of cardiac damage staging in women. A total of 334 women (mean age 81 ± 7 years) with severe AS undergoing TAVI were included and retrospectively analyzed. Echocardiography was performed before and 6 months after TAVI. Patients were classified according to the following stages of cardiac damage: 0 = no damage; 1 = left ventricular damage; 2 = left atrial or mitral valve damage; 3 = pulmonary vasculature or tricuspid valve damage; and 4 = right ventricular damage. The primary endpoint was all-cause mortality. Most patients presented with advanced heart failure symptoms (62% in NYHA III-IV). TAVI consistently improved cardiac damage of at least one stage in 43% of patients at 6-month follow-up. During a median follow-up of 48 months, 79 patients (24%) died. Each increment of both baseline (HR per 1-stage increment 1.537, P = 0.001) and follow-up (HR per 1-stage increment 1.714, P = 0.01) cardiac damage stage were independently associated with all-cause death. Moreover, the re-assessment of cardiac damage at 6-month follow-up provided incremental prognostic value over baseline assessment (Chi-square change = 6.885; P = 0.009). TAVI has a beneficial effect on cardiac function and remodeling in women. Cardiac damage assessed before and 6 months after TAVI showed to be consistently and independently associated with prognosis.

The online version contains supplementary material available at 10.1007/s10554-025-03424-8.

Figures