Background

Severe aortic valve stenosis (AS) is associated with extravalvular cardiac damage and a novel echocardiographic staging model was proposed to quantify the damage.

Objectives

This study aimed to validate the staging model in patients undergoing transcatheter aortic valve replacement (TAVR) and assess its prognostic impact on mid-term outcome.

Methods

841 patients with complete echocardiographic characterization undergoing TAVR between 2011 and 2016 were included in this analysis. Based on echocardiographic findings, the following staging was applied: isolated AS (Stage 0); left ventricular (LV) damage defined by increased LV mass index, LV ejection fraction <50% or E/e´>14 (stage 1); left atrial dilatation >34ml/m², moderate-severe mitral regurgitation or presence of atrial fibrillation (stage 2); pulmonary hypertension ≥ 60 mmHg or moderate to severe tricuspid regurgitation (stage 3); moderate-severe right ventricular dysfunction (stage 4). The primary endpoint was all-cause mortality at two years.

Results

Distribution across stages was 0.8% at stage 0, 7.5% at stage 1, 63.3% at stage 2, 18.3% and 10.1% at stage 3 and 4, respectively. Patients in higher stages suffered more frequently from NYHA class III/IV (p for the trend <0.001) as well as higher logistic EuroScore (p for the trend <0.001). All-cause mortality increased for each stage 1 through 4 (5.3%, 17.0%, 23.9% and 29.9%; p=0.013) as depicted in Figure 1. In the multivariate model, stage of cardiac damage, age, NYHA class III/IV, peripheral artery disease and previous pacemaker were independent predictors of the primary endpoint.

Conclusions

Patients treated for severe AS show high prevalence of extravalvular cardiac damage. Increase in stage of cardiac damage is associated with higher all-cause mortality at two years. Application of this staging model may provide an additive value to current treatment algorithms.