It was uncertain how aortic valve replacement (AVR) affects the progression/regression of extra valvular cardiac injury and its relationship to eventual prognosis. For a study, researchers sought to examine the progression of cardiac injury after AVR and its relationship to outcomes.

Patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2 and 3 studies who had transcatheter or surgical AVR were pooled and categorized by cardiac injury stage at baseline and 1 year (stage 0, no damage; stage 1, left ventricular damage; stage 2, left atrial or mitral valve damage; stage 3, pulmonary vasculature or tricuspid valve damage; and stage 4, right ventricular damage). The connection between the change in heart damage after AVR and 2-year outcomes was assessed using proportional hazards models.

Among 1,974 patients, 140 (7.1%) had stage 4 pre-AVR, 121 (6.1%) had stage 0, 287 (14.5%) had stage 1, 1,014 (51.4%) had stage 2, and 412 (20.9%) had stage 3. The degree of cardiac injury at baseline and after one year was related to two-year death. At 1 year, heart injury improved in ∼15% of patients compared to baseline, stayed stable in ∼60%, and worsened in ∼25% of patients, with mortality (adjusted HR for improvement: 0.49; no change: 1.00; worsening: 1.95; P=0.023) and the composite of death or heart failure hospitalization (adjusted HR for improvement: 0.60; no change: 1.00; worsening: 2.25; P<0.001) at 2 years, the 1-year change in cardiac damage stage was independently associated.

The degree of extravalvular cardiac injury at baseline and its change at 1 year had significant prognostic consequences in patients receiving AVR. According to the findings, global cardiac function and prognosis might be improved by earlier identification of aortic stenosis and intervention before the onset of irreparable heart damage.

Reference: jacc.org/doi/10.1016/j.jacc.2022.05.006