Brian R Lindman1, William J Stewart2, Philippe Pibarot3, Rebecca T Hahn4, Catherine M Otto5, Ke Xu6, Richard B Devereux7, Neil J Weissman8, Maurice Enriquez-Sarano9, Wilson Y Szeto10, Raj Makkar11, D Craig Miller12, Stamatios Lerakis13, Samir Kapadia2, Bruce Bowers14, Kevin L Greason9, Thomas C McAndrew6, Yang Lei15, Martin B Leon16, Pamela S Douglas17. 1. Washington University School of Medicine, St. Louis, Missouri. Electronic address: blindman@dom.wustl.edu. 2. Cleveland Clinic Foundation, Cleveland, Ohio. 3. Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada. 4. Columbia University Medical Center/New York Presbyterian Hospital, New York, New York. 5. University of Washington School of Medicine, Seattle, Washington. 6. Cardiovascular Research Foundation, New York, New York. 7. Weill Medical College, Cornell University, New York, New York. 8. Medstar Health Research Institute, Washington, DC. 9. Mayo Clinic, Rochester, Minnesota. 10. University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. 11. Cedars-Sinai Medical Center, Los Angeles, California. 12. Stanford University School of Medicine, Stanford, California. 13. Emory University School of Medicine, Atlanta, Georgia. 14. Medical City Dallas, Dallas, Texas. 15. Saint Luke's Mid-America Heart Institute, Kansas City, Missouri. 16. Columbia University Medical Center/New York Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York. 17. Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina.
Abstract
OBJECTIVES: This study sought to examine the relationship between left ventricular mass (LVM) regression and clinical outcomes after transcatheter aortic valve replacement (TAVR). BACKGROUND: LVM regression after valve replacement for aortic stenosis is assumed to be a favorable effect of LV unloading, but its relationship to improved clinical outcomes is unclear. METHODS: Of 2,115 patients with symptomatic aortic stenosis at high surgical risk receiving TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) randomized trial or continued access registry, 690 had both severe LV hypertrophy (left ventricular mass index [LVMi] ≥149 g/m(2) men, ≥ 122 g/m(2) women) at baseline and an LVMi measurement at 30-day post-TAVR follow-up. Clinical outcomes were compared for patients with greater than versus lesser than median percentage change in LVMi between baseline and 30 days using Cox proportional hazard models to evaluate event rates from 30 to 365 days. RESULTS: Compared with patients with lesser regression, patients with greater LVMi regression had a similar rate of all-cause mortality (14.1% vs. 14.3%, p = 0.99), but a lower rate of rehospitalization (9.5% vs. 18.5%, hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.32 to 0.78; p = 0.002) and a lower rate of rehospitalization specifically for heart failure (7.3% vs. 13.6%, p = 0.01). The association with a lower rate of rehospitalization was consistent across subgroups and remained significant after multivariable adjustment (HR: 0.53, 95% CI: 0.34 to 0.84; p = 0.007). Patients with greater LVMi regression had lower B-type natriuretic peptide (p = 0.002) and a trend toward better quality of life (p = 0.06) at 1-year follow-up than did those with lesser regression. CONCLUSIONS: In high-risk patients with severe aortic stenosis and severe LV hypertrophy undergoing TAVR, those with greater early LVM regression had one-half the rate of rehospitalization over the subsequent year compared to those with lesser regression.
RCT Entities:
OBJECTIVES: This study sought to examine the relationship between left ventricular mass (LVM) regression and clinical outcomes after transcatheter aortic valve replacement (TAVR). BACKGROUND: LVM regression after valve replacement for aortic stenosis is assumed to be a favorable effect of LV unloading, but its relationship to improved clinical outcomes is unclear. METHODS: Of 2,115 patients with symptomatic aortic stenosis at high surgical risk receiving TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) randomized trial or continued access registry, 690 had both severe LV hypertrophy (left ventricular mass index [LVMi] ≥ 149 g/m(2) men, ≥ 122 g/m(2) women) at baseline and an LVMi measurement at 30-day post-TAVR follow-up. Clinical outcomes were compared for patients with greater than versus lesser than median percentage change in LVMi between baseline and 30 days using Cox proportional hazard models to evaluate event rates from 30 to 365 days. RESULTS: Compared with patients with lesser regression, patients with greater LVMi regression had a similar rate of all-cause mortality (14.1% vs. 14.3%, p = 0.99), but a lower rate of rehospitalization (9.5% vs. 18.5%, hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.32 to 0.78; p = 0.002) and a lower rate of rehospitalization specifically for heart failure (7.3% vs. 13.6%, p = 0.01). The association with a lower rate of rehospitalization was consistent across subgroups and remained significant after multivariable adjustment (HR: 0.53, 95% CI: 0.34 to 0.84; p = 0.007). Patients with greater LVMi regression had lower B-type natriuretic peptide (p = 0.002) and a trend toward better quality of life (p = 0.06) at 1-year follow-up than did those with lesser regression. CONCLUSIONS: In high-risk patients with severe aortic stenosis and severe LV hypertrophy undergoing TAVR, those with greater early LVM regression had one-half the rate of rehospitalization over the subsequent year compared to those with lesser regression.
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