Background: In elderly aortic stenosis (AS) patients undergoing transcatheter aortic valve implantation (TAVI), depression is a frequently occurring co-morbidity. Patients showing pathologic values for depression prior to TAVI, there was a significant decrease after 6 weeks remaining stable at least until the 12 months’ follow-up in association to functional improvements. Besides these relevant observation with great impact for quality of life, the question arises, whether these findings are of prognostic impact, in particular with respect to long-term mortality. The aim of our current study was to test the value of both, preexisting depression and its dynamics after TAVI as predictors of 2-year survival in a real-world setting.

Methods:

A total of 341 patients with severe AS undergoing transfemoral TAVI at the University Hospital Jena and gave informed consent to participate in the Jenaer Aortenklappenregister (JAKR) were included in the study. Besides a wide range of clinical, laboratory, functional and imaging parameters, depression was prospectively assessed using the German version of the well-established Hospital Anxiety and Depression Scale (HADS-D) according to the local study protocol at baseline as well as 6 weeks after TAVI. Mortality was recorded at 30 days, 1 year and 2 years (long-term) after TAVI. By using 8 points for depression in HADS-D as cut-off-value, patients were divided into a non-depressive and a depressive group both, before and 6 weeks after TAVI. In addition, intra-individual dynamics were recorded.

Results: The mean age of patients in this typical TAVI cohort was 79 ± 7 years, 52% were female and the mean STS score was 4.9 ± 3.8%. The mortality rates were as follows: 3.5% after 30 days, 16.7% after 1 and 22.9% after 2 years. In the entire collective, the percentage of patients classified as depressive, was 27.9% (n=95) prior to TAVI without significant changes 6-week after TAVI. For both time-points, the presence of depression as defined above, did not show any association to 30-day, 1-year and 2-years (long-term) mortality (p=n.s.). After assessment of intra-individual dynamics in the depression value of HADS-D prior to and after TAVI, there were four groups of patients: non-depressive patients with equal or better values (n=75, 49%), non-depressive patients with worse values (n=78, 51%), depressive patients with equal or worse values (n=18, 27%) and depressive patients with improved values (n=48, 73%). In contrast to non-depressive patients (p=n.s.) showing no significant dynamics after TAVI, patients with pre-existing depression showed a statistically significant improvement (p<0.001). When comparing non-depressive patients with equal or better values with those showing worse values after TAVI, the 2-year survival rates are 88.0% and 82.1%, respectively (p=n.s.). When comparing depressive patients with equal or worse values with those showing better values after TAVI, the 2-year survival rates are 77.8% and 93.8%, respectively (p=0.062). 

Conclusions: Pre-existing depression in AS patients undergoing TAVI does not show an association to both, short- and long-term mortality up to 2-years of follow-up. As already shown recently, there is a significant improvement of depression in these patients after TAVI being of great impact for patients’ quality of life. Moreover, there is a trend towards a better long-term survival of patients with pre-existing depression showing improvements after TAVI.