Author + information
- Received January 16, 2020
- Revision received February 20, 2020
- Accepted March 3, 2020
- Published online June 1, 2020.
- Holly Gonzales, MDa,b,
- Pamela S. Douglas, MDc,
- Philippe Pibarot, DVM, PhDd,
- Rebecca T. Hahn, MDe,
- Omar K. Khalique, MDe,
- Wael A. Jaber, MDf,
- Paul Cremer, MDf,
- Neil J. Weissman, MDg,
- Federico M. Asch, MDg,
- Yiran Zhang, MSh,
- Zachary M. Gertz, MDi,
- Sammy Elmariah, MD, MPHj,
- Marie-Annick Clavel, DVM, PhDd,
- Vinod H. Thourani, MDk,
- Melissa Daubert, MDc,
- Maria C. Alu, MSe,h,
- Martin B. Leon, MDe,h and
- Brian R. Lindman, MD, MSca,b,∗ (, )@vumcvalve
- aStructural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee
- bCardiovascular Medicine Division, Vanderbilt University Medical Center, Nashville, Tennessee
- cDuke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- dInstitut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
- eStructural Heart and Valve Center, Columbia University Irving Medical Center/NewYork Presbyterian Hospital, New York, New York
- fDepartment of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- gMedStar Health Research Institute, Georgetown University, Washington, DC
- hCardiovascular Research Foundation, New York, New York
- iDepartment of Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
- jDepartment of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- kDepartment of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Georgia
- ↵∗Address for correspondence:
Dr. Brian R. Lindman, Structural Heart and Valve Center, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 300-A, Nashville, Tennessee 37203.
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.
Background Prior studies assessing the association between baseline LVH and outcomes after surgical or TAVR for aortic stenosis (AS) have yielded conflicting results.
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.
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.
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.
- aortic stenosis
- left ventricular hypertrophy
- transcatheter aortic valve replacement
This work was funded by Edwards Lifesciences. Dr. Douglas has received a grant to her institution from Edwards Lifesciences. Dr. Pibarot has had research contracts with Edwards Lifesciences for echo core lab analyses with no personal compensation; and with Medtronic for in vitro analyses. Dr. Hahn has received speaker fees from Boston Scientific Corporation, Abbott Vascular, Edwards Lifesciences, Philips Healthcare, Siemens Healthineers, and Baylis Medical; has been a consultant for Abbott Structural, Edwards Lifesciences, Gore & Associates, Medtronic, Navigate, Philips Healthcare, and Siemens Healthineers; has received nonfinancial support from 3mensio Medical Imaging and GE Healthcare; and is chief scientific officer for the echocardiography core laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. Dr. Khalique has received speaker fees from Edwards Lifesciences; has been a consultant for Boston Scientific and Abbott Structural; and has read in a core lab for the PARTNER studies, with no direct compensation. Drs. Jaber and Cremer have echocardiography core laboratory contracts with Edwards Lifesciences (no direct compensation). Dr. Weissman has received grant support through his institution for his echocardiography core lab work with Edwards Lifesciences, Abbott, Boston Scientific, Medtronic, Livanova, and Biotronik. Dr. Asch is director of a core lab with institutional support from Edwards Lifesciences, Abbott, Boston Scientific, Medtronic, Livanova, and Biotronik. Dr. Elmariah has received research grants from Edwards Lifesciences; and has served as a consultant for Medtronic, AstraZeneca, and the Cardiovascular Research Foundation. Dr. Clavel has a computed tomography core laboratory contract with Edwards Lifesciences and research grant with Medtronic, for which she receives no direct compensation. Dr. Thourani has received research support from Edwards Lifesciences, Boston Scientific, and JenaValve; and has received consulting fees from Edwards Lifesciences, Boston Scientific, Abbott, Gore Vascular, and JenaValve. Ms. Alu’s institution has received research funding from Edwards Lifesciences. Dr. Leon has received institutional research funding from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott; has consulted for Medtronic, Boston Scientific, Gore Medical, Meril Lifesciences, and Abbott; and is member of the executive committee for the PARTNER trials (no direct compensation). Dr. Lindman has served on a scientific advisory board for Roche Diagnostics; has received research grants from Edwards Lifesciences and Roche Diagnostics; and has consulted for Medtronic and Roche Diagnostics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The author attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received January 16, 2020.
- Revision received February 20, 2020.
- Accepted March 3, 2020.
- 2020 American College of Cardiology Foundation
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