# Eccentric hypertrophy impairs outcome after TAVR

## TL;DR

Eccentric heart muscle thickening in aortic stenosis patients leads to worse outcomes after valve replacement surgery.

## Contribution

Identified eccentric hypertrophy as a novel predictor of poor long-term outcomes after TAVR, supported by genetic insights.

## Key findings

- Eccentric hypertrophy (EH) showed significantly higher mortality rates at 1 and 4 years post-TAVR compared to other groups.
- Higher polygenic risk scores for hypertrophic cardiomyopathy were linked to reduced likelihood of EH in AS patients.
- EH patients had worse 1-year and 5-year outcomes than concentric hypertrophy or normal geometry groups.

## Abstract

Aortic stenosis (AS) induces cardiac remodeling upon chronic left ventricular (LV) pressure overload. Here, we analyzed the clinical outcome of patients undergoing transcatheter aortic valve replacement (TAVR) for symptomatic AS with regard to varying LV hypertrophy patterns. Moreover, we investigated the genetic influence on development of different hypertrophy patterns, measured by polygenic risk scores (PRS).

1703 patients with severe AS undergoing TAVR were categorized according to LV mass index and relative wall thickness in four subgroups: normal geometry (NG, n = 57), concentric remodeling (CR; n = 388), concentric hypertrophy (CH; n = 993) and eccentric hypertrophy (EH; n = 265). Data was analyzed retrospectively with regard to clinical outcome. In a substudy, 520 patients affected by CH (n = 237), EH (n = 139) or CR (n = 164) were analyzed using two PRS that have been previously associated with hypertrophic and dilated cardiomyopathy.

1 year after TAVR, for EH, in contrast to the remaining groups (NG, CR, CH), a significant difference in all-cause mortality was observable (mortality 17.4% EH, 14.0% NG, 12.4% CR, 14.0% CH, p = 0.001). This difference was observed up to 4 years (mortality 41.9% EH, 26.9% CH, 28.1% CR, 26.4% NG, p = 0.001). Of note, higher percentiles in a PRS for hypertrophic cardiomyopathy were associated with a reduced likelihood of EH in patients with AS (p = 0.046).

The EH group had a statistically significant poorer 1-year and 5-year outcomes than the other groups. PRS might help predict myocardial reactions in patients with aortic stenosis in future.

The online version contains supplementary material available at 10.1007/s00392-024-02582-4.