Author + information
- Received February 21, 2020
- Accepted March 15, 2020
- Published online May 11, 2020.
- Katherine H. Chau, MDa,b,
- Pamela S. Douglas, MDc,
- Philippe Pibarot, DVM, PhDd,
- Rebecca T. Hahn, MDb,
- Omar K. Khalique, MDb,
- Wael A. Jaber, MDe,
- Paul Cremer, MDe,
- Neil J. Weissman, MDf,
- Federico M. Asch, MDf,
- Yiran Zhang, MSa,
- Zachary M. Gertz, MDg,
- Sammy Elmariah, MD, MPHh,
- Marie-Annick Clavel, DVM, PhDd,
- Vinod H. Thourani, MDi,
- Melissa Daubert, MDc,
- Maria C. Alu, MSa,b,
- Martin B. Leon, MDa,b and
- Brian R. Lindman, MD, MScj,k,∗ (, )@vumcvalve
- aCardiovascular Research Foundation, New York, New York
- bStructural Heart and Valve Center, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York
- cDuke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- dInstitut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
- eDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- fMedstar Health Research Institute, Georgetown University, Washington, DC
- gVirginia Commonwealth University School of Medicine, Richmond, Virginia
- hMassachusetts General Hospital, Boston, Massachusetts
- iDepartment of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Georgia
- jStructural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee
- kCardiovascular Medicine Division, Vanderbilt University Medical Center, Nashville, Tennessee
- ↵∗Address for correspondence:
Dr. Brian R. Lindman, Structural Heart and Valve Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 300-A, Nashville, Tennessee 37203.
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/m2 (interquartile range [IQR]: 133 to 168 g/m2) at baseline and decreased 14.5% (IQR: 4.2% to 26.1%) to 126 g/m2 (IQR: 106 to 148 g/m2) 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.
- aortic stenosis
- left ventricular hypertrophy
- left ventricular mass regression
- transcatheter aortic valve replacement
Dr. Douglas has received a grant to her institution from Edwards Lifesciences. Dr. Pibarot has research contracts with Edwards Lifesciences for echo core lab analyses, with no personal compensation. Dr. Hahn has received speaker fees from Boston Scientific Corporation, Baylis Medical, Edwards Lifesciences, and Medtronic; has served as a consultant for Abbott Structural, Edwards Lifesciences, Gore and Associates, Medtronic, Navigate, Philips Healthcare, and Siemens Healthcare; has received nonfinancial support from 3mensio and GE Healthcare; and has served as Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. Dr. Khalique has received speaker fees from Edwards Lifesciences; and has read in a core laboratory for the PARTNER studies, with no direct compensation. Drs. Jaber and Cremer have echocardiography core laboratory contracts with Edwards Lifesciences (no direct compensation). Dr. Weissman is the President of MedStar Health Research Institute, which has echocardiography core laboratory research contracts with Edwards Lifesciences, Abbott, Boston Scientific, Medtronic, Livanova, and Biotronik. Dr. Asch’s institution (MedStar Health) has research contracts for his work as core laboratory director with Edwards Lifesciences, Abbott, Boston Scientific, Medtronic, Livanova, and Biotronik. Dr. Elmariah has received research grants from Edwards Lifesciences; and has served as a consultant for Medtronic, AstraZeneca, and the Cardiovascular Research Foundation. Dr. Clavel has a computed tomography core laboratory contract with Edwards Lifesciences and research grant with Medtronic, for which she receives no direct compensation. Dr. Thourani has received research support from Edwards Lifesciences, Boston Scientific, and JenaValve; and has received consulting fees from Edwards Lifesciences, Boston Scientific, Abbott, Gore Vascular, and JenaValve. Ms. Alu’s institution has received research funding from Edwards Lifesciences. Dr. Leon has received institutional research funding from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott; has served as a consultant for Medtronic, Boston Scientific, Gore Medical, Meril Lifesciences, and Abbott; and has served as a member of the Executive Committee for the PARTNER Trials (no direct compensation). Dr. Lindman has served on the Scientific Advisory Board for Roche Diagnostics; has received research grants from Edwards Lifesciences and Roche Diagnostics; and has served as a consultant for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received February 21, 2020.
- Accepted March 15, 2020.
- 2020 American College of Cardiology Foundation
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