The following is a summary of “Cardiac Damage and Quality of Life After Aortic Valve Replacement in the PARTNER Trials,” published in the February 2023 issue of Cardiology by Généreux, et al.
For a study, researchers sought to evaluate the relationship between the extent of extravalvular cardiac damage and health outcomes among patients with severe aortic stenosis undergoing aortic valve replacement (AVR).
The research utilized data from the PARTNER (Placement of Aortic Transcatheter Valves) 2 and 3 trials, and the patients were classified based on echocardiographic cardiac damage stage at baseline and one year after AVR, ranging from stage 0-4. In addition, the study analyzed the association between baseline cardiac damage and one-year health status, measured using the Kansas City Cardiomyopathy Questionnaire Overall Score (KCCQ-OS).
The study involved 1,974 patients who underwent AVR, with 794 surgical AVR and 1,180 transcatheter AVR. The findings showed that the extent of cardiac damage at baseline was significantly associated with lower KCCQ scores at baseline and one year after AVR (P<0.0001). Additionally, patients with higher baseline cardiac damage were found to have an increased risk of poor outcomes (death, KCCQ-OS <60, or a decrease in KCCQ-OS of ≥10 points) at one year (stages 0-4: 10.6% vs 19.6% vs 29.0% vs 44.7% vs 39.8%; P < 0.0001). The multivariable model demonstrated that every one-stage increase in baseline cardiac damage was associated with a 24% increase in the odds of poor outcomes (95% CI: 9%-41%; P=0.001). The change in the stage of cardiac damage at one year after AVR was also associated with the extent of improvement in KCCQ-OS over the same period, with the mean change in KCCQ-OS score (mean change in 1-year KCCQ-OS: improvement of ≥1 stage +26.8 [95% CI: 24.2-29.4] vs no change +21.4 [95% CI: 20.0-22.7] vs deterioration of ≥1 stage +17.5 [95% CI: 15.4-19.5]; P < 0.0001).
In conclusion, the study findings suggested that the extent of extravalvular cardiac damage before AVR was significantly associated with health status outcomes both cross-sectionally and after AVR. The findings underscored the importance of evaluating and managing extravalvular cardiac damage in patients with severe aortic stenosis undergoing AVR to improve postoperative health outcomes.