Background: Patients with symptomatic aortic stenosis are a vulnerable population with associated cardiac damage and a significant comorbidity burden. This study aimed to determine the rate, factors associated with, and prognostic value of poor functional status (NYHA class III-IV) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).
Methods: This multicenter study included 6,363 transarterial TAVR patients, classified according to baseline functional status (NYHA class I-II vs. III-IV).
Results: A total of 3,800 (60%) patients presented an NYHA class III-IV before the TAVR procedure. Atrial fibrillation (OR:1.32,95%CI:1.11-1.58,p=0.002), chronic kidney disease (OR:1.73, 95%CI:1.45-2.05, p<0.001), COPD (OR:1.65,95%CI: 1.32-2.05), p<0.001), reduced LVEF (OR:2.28, 95%CI:1.70-3.05, p<0.001), and moderate and severe pulmonary hypertension were associated with a poor functional status. At 1-year follow-up, patients with NYHA class III-IV presented a higher rate of mortality (8.81 per 100 person-years, 95%CI: 7.57-10.15 vs. 13.12 per 100 person-year - 95%CI: 11.80-14.58, log-rank p<0.001) and heart failure hospitalization (8.25 per 100 person-years - 95%CI: 7.05-9.65 vs. 12.5 per 100 person-years - 95%CI: 11.24-14.00, log-rank p=0.005). Comorbidity factors (COPD, CKD) and signs of cardiac damage (atrial fibrillation, pulmonary hypertension) determined an increased risk of poorer clinical outcomes (p<0.01 for all).
Conclusions: More than one-half of patients undergoing TAVR in the contemporary era presented an advanced functional class before the procedure, and this was associated with a greater comorbidity and cardiac damage burden. Patients with poorer baseline functional status exhibited worse clinical outcomes at 1-year follow-up. These findings highlight the importance of future studies on earlier interventions for aortic stenosis patients.
Keywords: NYHA; TAVI; TAVR; dyspnea; functional class.
Copyright © 2024. Published by Elsevier Inc.