Comparison of Early and Long-Term Outcomes After Transcatheter Aortic Valve Implantation in Patients with New York Heart Association Functional Class IV to those in Class III and Less

Marianna Adamo, Claudia Fiorina, Anna Sonia Petronio, Cristina Giannini, Corrado Tamburino, Marco Barbanti, Francesco Bedogni, Luca Testa, Antonio Colombo, Azeem Latib, Giuseppe Bruschi, Bernhard Reimers, Arnaldo Poli, Marco Stefano Nazzaro, Salvatore Curello, Federica Ettori

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Abstract

Our aim was to investigate the impact of a baseline New York Heart Association (NYHA) class IV on clinical outcomes of a large real-world population who underwent transcatheter aortic valve implantation (TAVI). The primary end points were all-cause mortality, cardiovascular mortality, and re-hospitalization, evaluated at the longest available follow-up and by means of a 3-month landmark analysis. The secondary end points were: change in NYHA class, left ventricular ejection fraction, pulmonary pressure and mitral regurgitation. Out of 2,467 patients, 271 (11%) had a NYHA functional class IV at the admission. The latter had higher Society of Thoracic Surgeons (STS) score (9.2% vs 5.5%; p < 0.001) compared to NYHA ≤ III patients, owing to more comorbidities (prior myocardial infarction, severe long-term kidney disease, atrial fibrillation, left ventricular dysfunction, significant mitral regurgitation, pulmonary hypertension). Device success was similar between the two groups (93.7% vs 94.5%; p = 0.583). At a median follow-up of 15 months (interquartile range 4 to 36 months) a lower freedom from primary end points was observed among NYHA IV versus NYHA ≤ III group (survival from all-cause death: 52% vs 58.4%; p = 0.002; survival from cardiovascular death: 72.5% vs 76.5%; p = 0.091; freedom from re-hospitalization: 81.5% vs 85.4%; p = 0.038). However, after adjustment for baseline imbalance, NYHA IV did not influence the relative risk of long-term primary end points. A 3-month landmark analysis showed that NYHA IV independently predicted 3-month all-cause and cardiovascular mortality (hazard ratio: 1.77; 95% CI [1.10 to 2.83]; p = 0.018 and hazard ratio: 1.64; 95% CI [1.03 to 2.59]; p = 0.036, respectively). Instead, after 3-month follow-up NYHA IV did not affect the risk of primary end points. A significant improvement of the secondary end points was noted in both NYHA IV and NYHA ≤≤ III groups. In conclusion, the presence of NYHA class IV in TAVI candidates was associated to a significant increased risk of mortality within 3 months. Patients with baseline NYHA IV who survived at 3 months had a long-term outcome comparable to that of other subjects. Left ventricular systolic function, pulmonary pressure, and mitral insufficiency significantly improved after TAVI regardless of baseline NYHA class IV.

Original languageEnglish
Pages (from-to)1718-1726
Number of pages9
JournalAmerican Journal of Cardiology
Volume122
Issue number10
DOIs
Publication statusPublished - Nov 15 2018

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Adamo, M., Fiorina, C., Petronio, A. S., Giannini, C., Tamburino, C., Barbanti, M., Bedogni, F., Testa, L., Colombo, A., Latib, A., Bruschi, G., Reimers, B., Poli, A., Nazzaro, M. S., Curello, S., & Ettori, F. (2018). Comparison of Early and Long-Term Outcomes After Transcatheter Aortic Valve Implantation in Patients with New York Heart Association Functional Class IV to those in Class III and Less. American Journal of Cardiology, 122(10), 1718-1726. https://doi.org/10.1016/j.amjcard.2018.08.006