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Left Ventricular Hypertrophy and Clinical Outcomes Over 5 Years After TAVR: An Analysis of the PARTNER Trials and Registries.

by Asch, Federico M; Weissman, Neil J.
Citation: Jacc: Cardiovascular Interventions. 13(11):1329-1339, 2020 06 08.; .Journal: JACC. Cardiovascular interventions.Published: 2020; ; ; ISSN: 1936-8798.Full author list: Alu MC; Asch FM; Clavel MA; Cremer P; Daubert M; Douglas PS; Elmariah S; Gertz ZM; Gonzales H; Hahn RT; Jaber WA; Khalique OK; Leon MB; Lindman BR; Pibarot P; Thourani VH; Weissman NJ; Zhang Y.UI/PMID: 32499024.Subject(s): *Aortic Valve Stenosis/su [Surgery] | *Aortic Valve/su [Surgery] | *Hypertrophy, Left Ventricular/pp [Physiopathology] | *Transcatheter Aortic Valve Replacement | *Ventricular Function, Left | *Ventricular Remodeling | Aged | Aged, 80 and over | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/pp [Physiopathology] | Clinical Trials as Topic | Female | Humans | Hypertrophy, Left Ventricular/dg [Diagnostic Imaging] | Hypertrophy, Left Ventricular/mo [Mortality] | Male | Patient Readmission | Postoperative Complications/mo [Mortality] | Postoperative Complications/th [Therapy] | Recovery of Function | Registries | Risk Assessment | Risk Factors | Severity of Illness Index | Time Factors | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Transcatheter Aortic Valve Replacement/mo [Mortality] | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.jcin.2020.03.011https://dx.doi.org/10.1016/j.jcin.2020.03.011 (Click here) | (Click here) Abbreviated citation: JACC Cardiovasc Interv. 13(11):1329-1339, 2020 06 08; .Abstract: BACKGROUND: Prior studies assessing the association between baseline LVH and outcomes after surgical or TAVR for aortic stenosis (AS) have yielded conflicting results.Abstract: CONCLUSIONS: Severe baseline LVH is associated with higher 5-year death and rehospitalization rates after TAVR. These findings may have implications for the optimal timing of valve replacement and the potential role for medical therapy to slow or prevent LVH as AS progresses before valve replacement, but further studies are needed. Copyright (c) 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.Abstract: METHODS: Patients with severe symptomatic AS at intermediate or high risk in the PARTNER (Placement of Aortic Transcatheter Valve) 1, 2, and S3 trials and registries who received TAVR and had baseline measurements for left ventricular mass index (LVMi) were analyzed. The presence and severity of LVH was determined by LVMi using American Society of Echocardiography sex-specific cutoffs.Abstract: OBJECTIVES: This study sought to evaluate the association between severity of left ventricular hypertrophy (LVH) before transcatheter aortic valve replacement (TAVR) and outcomes out to 5 years.Abstract: RESULTS: Among 4,280 patients, those with no (n = 1,325), mild (n = 777), moderate (n = 628), and severe (n = 1,550) LVH had 5-year rates of death of 32.8%, 37.3%, 37.2%, and 44.8%, respectively (p < 0.001), and 5-year rates of cardiovascular (CV) death or rehospitalization of 33.6%, 39.2%, 42.4%, and 49.2%, respectively (p < 0.001). After adjustment, severe LVH (compared with no LVH) was associated with increased all-cause death (adjusted hazard ratio: 1.16; 95% confidence interval: 1.00 to 1.34; p = 0.04) and CV death or rehospitalization (adjusted hazard ratio: 1.34; 95% confidence interval: 1.16 to 1.54; p < 0.001), but no increased hazard was observed for mild or moderate LVH. In spline analyses performed in males and females separately, there was a consistent linear association between increased LVMi and an increased adjusted hazard of CV mortality or rehospitalization. A similar relationship was observed for all-cause death in females, but not males.

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