Author + information
- Received August 16, 2018
- Revision received October 21, 2018
- Accepted November 13, 2018
- Published online February 18, 2019.
- Anubodh S. Varshney, MDa,
- Pratik Manandhar, MSb,
- Sreekanth Vemulapalli, MDb,c,
- Ajay J. Kirtane, MD, SMd,
- Verghese Mathew, MDe,
- Binita Shah, MDf,
- Angela Lowenstern, MDb,c,
- Andrzej S. Kosinski, PhDb,g,
- Tsuyoshi Kaneko, MDh,
- Vinod H. Thourani, MDi and
- Deepak L. Bhatt, MD, MPHa,∗ ()
- aBrigham and Women’s Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
- bDuke Clinical Research Institute, Durham, North Carolina
- cDivision of Cardiology, Duke University, Durham, North Carolina
- dDivision of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
- eDivision of Cardiology, Stritch School of Medicine, Loyola University, Chicago, Illinois
- fDivision of Cardiology, VA New York Harbor Healthcare System and New York University School of Medicine, New York, New York
- gDepartment of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
- hDepartment of Cardiac Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- iDepartment of Cardiac Surgery, Medstar Heart and Vascular Institute/Georgetown University, Washington, DC
- ↵∗Address for correspondence:
Dr. Deepak L. Bhatt, Brigham and Women’s Hospital, Heart and Vascular Center, Harvard Medical School, 75 Francis Street, Boston, Massachusetts 02115.
Objectives The aim of this study was to evaluate the association between pre-procedural left ventricular hypertrophy (LVH) patterns and clinical outcomes after transcatheter aortic valve replacement (TAVR).
Background The association between pre-procedural LVH pattern and severity and clinical outcomes after TAVR is uncertain.
Methods Patients (n = 31,199) across 422 sites who underwent TAVR from November 2011 through June 2016 as part of the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapies) Registry linked with the Centers for Medicare and Medicaid Services database were evaluated by varying LVH patterns, according to sex-specific cutoffs for left ventricular mass index and relative wall thickness. The association between LVH pattern (concentric remodeling, concentric LVH, and eccentric LVH) and outcomes (rates of mortality, myocardial infarction [MI], stroke, new dialysis requirement) at 1-year follow-up were evaluated using multivariate hazard models.
Results There were no significant associations between concentric remodeling (death: adjusted hazard ratio [HR]: 1.03; 95% confidence interval [CI]: 0.93 to 1.15; MI: HR: 1.05; 95% CI: 0.76 to 1.46; stroke: HR: 1.11; 95% CI: 0.89 to 1.39; new dialysis: HR: 0.86; 95% CI: 0.64 to 1.15), concentric LVH (death: HR: 1.04; 95% CI: 0.95 to 1.15; MI: HR: 1.12; 95% CI: 0.82 to 1.52; stroke: HR: 1.14; 95% CI: 0.92 to 1.40; new dialysis: HR: 1.17; 95% CI: 0.90 to 1.52), or eccentric LVH (death: HR: 0.98; 95% CI: 0.87 to 1.10; MI: HR: 1.07; 95% CI: 0.71 to 1.63; stroke: HR: 1.01; 95% CI: 0.78 to 1.32; new dialysis: HR: 1.25; 95% CI: 0.92 to 1.70) and outcomes at 1 year compared with patients without LVH.
Conclusions In a contemporary cohort of patients who underwent TAVR, pre-procedural LVH according to left ventricular mass index and relative wall thickness was not associated with adverse outcomes at 1-year follow-up. TAVR is likely to benefit patients with severe aortic stenosis regardless of the presence of LVH.
This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry and the Society of Thoracic Surgeons. Dr. Vemulapalli has received research grants from the American College of Cardiology, the Society of Thoracic Surgeons, the Patient-Centered Outcomes Research Institute, Boston Scientific, and Abbott Vascular; and is a consultant and member of the Speakers Bureau for Boston Scientific, Janssen, Premiere, and Pfizer. Dr. Kirtane has received institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, Cardiovascular Systems Inc., CathWorks, Siemens, Philips, and ReCor Medical. Dr. Shah has received research grants from the VA Office of Research and Development (iK2CX001074) and Siemens Medical Solutions; and is a member of the advisory board of Philips Volcano. Dr. Lowenstern has received research grants from the National Institutes of Health (T-32 training grant 5 T32 HL069749-14). Dr. Kosinski has received research grants from the American College of Cardiology, the American Heart Association, the Society of Thoracic Surgeons, and the Patient-Centered Outcomes Research Institute. Dr. Kaneko is a member of the Speakers Bureau of Edwards Lifesciences, Medtronic, and Abbott. Dr. Bhatt is a member of the advisory boards of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; is a member of the boards of directors of the Boston VA Research Institute, the Society of Cardiovascular Patient Care, and TobeSoft; is chair of the American Heart Association Quality Oversight Committee; is a member of the data monitoring committees of the Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), the Cleveland Clinic, the Duke Clinical Research Institute, the Mayo Clinic, the Mount Sinai School of Medicine, and the Population Health Research Institute; has received honoraria from the American College of Cardiology (senior associate editor, Clinical Trials and News, ACC.org; vice chair, ACC Accreditation Committee), the Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim), Belvoir Publications (editor-in-chief, Harvard Heart Letter), the Duke Clinical Research Institute (clinical trial steering committees), HMP Global (editor-in-chief, Journal of Invasive Cardiology), the Journal of the American College of Cardiology (guest editor, associate editor), the Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and U.S. national coleader, funded by Bayer), Slack Publications (chief medical editor, Cardiology Today’s Intervention), the Society of Cardiovascular Patient Care (secretary/treasurer), WebMD (continuing medical education steering committees); is deputy editor of Clinical Cardiology, chair of the NCDR-ACTION Registry Steering Committee, and chair of the VA CART Research and Publications Committee; has received research funding from Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi, Synaptic, and The Medicines Company; has received royalties from Elsevier (editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); is a site co-investigator for Biotronik, Boston Scientific, St. Jude Medical (now Abbott), and Svelte; is a trustee of the American College of Cardiology; and has conducted unfunded research for FlowCo, Merck, Novo Nordisk, PLx Pharma, and Takeda. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 16, 2018.
- Revision received October 21, 2018.
- Accepted November 13, 2018.
- 2019 American College of Cardiology Foundation
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