Quality of life in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: tools and evidence

Computed tomography-based coronary lumen volume to myocardial mass ratio in patients undergoing transcatheter aortic valve replacement: a novel method for risk assessment

BACKGROUND

The coronary lumen volume to myocardial mass (V/M) ratio has been suggested as a quantitative metric of potential imbalance between coronary blood supply and myocardial oxygen demand. This study was designed to assess the prognostic value of the V/M ratio for predicting major adverse cardiovascular events (MACE) in patients undergoing transcatheter aortic valve replacement (TAVR).

METHODS

This study enrolled patients who received a standard planning computed tomography (CT) scan before TAVR and dichotomized at the median of 33.31 mm³/g of V/M ratio into groups with low V/M ratio and high V/M ratio. The V/M ratio was calculated by coronary computed tomography angiography (CTA). The endpoint was a composite of all-cause mortality, stroke, and hospitalization for heart failure. The cumulative incidence of the MACE was compared using Kaplan-Meyer plots and uni- and multivariate Cox proportional hazards regression analysis.

RESULTS

In total, 139 patients were enrolled in this study finally (mean age 71.7 ± 6.7 years, 41.7% female). The mean V/M ratio was considerably lower in patients with MACE than in those without MACE (26.5 ± 4.9mm3/g vs. 34.0 ± 3.8mm3/g, P<0.001). Multivariate Cox proportional hazards regression showed that the low V/M ratio group (≤ 33.31 mm³/g) had a higher risk of MACE after TAVR (HR: 6.14, 95%CI: 1.37-27.54; P = 0.018).

CONCLUSIONS

The lower V/M ratio could serve as an independent predictor of MACE in patients undergoing TAVR.

CLINICAL TRIAL NUMBER

Not applicable.

Associations between new-onset postoperative atrial fibrillation and changes in left ventricular mass index in patients undergoing transcatheter aortic valve replacement

BACKGROUND

New-onset postoperative atrial fibrillation (POAF) is common after transcatheter aortic valve replacement (TAVR). At present, the impact of POAF on cardiac remodeling after TAVR has not been thoroughly studied.

OBJECTIVES

To investigate the impact of POAF on cardiac remodeling and its association with clinical outcomes after TAVR.

METHODS

601 patients undergoing TAVR for severe aortic stenosis were evaluated. Of these, 253 patients were identified to have POAF, which was categorized as normal left ventricular mass index (LVMI) in 54 (21%) and high LVMI in 199 (79%). The primary endpoint was a composite of all-cause death, heart failure rehospitalization and disabling stroke. Reverse remodeling was assessed by transthoracic echocardiography.

RESULTS

In POAF patients, the 3-year cumulative incidence of primary composite outcome in the high LVMI subgroup was significantly higher than that in the normal LVMI subgroup (9.3 ± 3.3% vs. 13.5 ± 3.9%; p = 0.02). The incidence of LVMI regression after TAVR was lower in patients with POAF than in those without (65.6 ± 3.0% vs. 82.6 ± 2.7% at 3 years; p = 0.029). Furthermore, the 3-year cumulative incidence of the primary composite outcome and cardiovascular death was highest in the group of POAF without LVMI regression. Baseline LVMI (β = -1.73, p < 0.001) and POAF (β = -1.46, p < 0.001) were independent predictors of change in LVMI at one year.

CONCLUSIONS

Patients with POAF had less LVMI regression and impaired cardiac reverse remodeling after TAVR, which increased the incidence of all-cause death and heart failure rehospitalization. Therefore, clinicians should be more proactive in monitoring and treating POAF after TAVR.

Toronto Aortic Stenosis Quality of Life Questionnaire (TASQ): Validation in Polish Patients with Aortic Stenosis

Background/Objectives: Quality of life (QoL) is recognized as a clinically significant outcome measure among patients with aortic stenosis (AS). However, there is no validated, AS-specific questionnaire available in Poland for assessing the QoL in AS patients. The aim of the study was to determine the psychometric properties of the Polish version of the Toronto Aortic Stenosis Quality of Life Questionnaire (the TASQ). Methods: The study involved 113 patients with severe AS (including 59 women), aged 74 to 82 years [mean age 77 years], hospitalized at the department of cardiology in 2024. The standardized questionnaires were used to assess the level of QoL, the TASQ, and the Minnesota Living with Heart Failure Questionnaire (the MLHFQ). Results: The mean QoL level assessed by the TASQ was 60.72 ± 22.82. The Cronbach's alpha for the entire TASQ was 0.919, for the emotional impact subscale 0.873, and for the physical limitation subscale 0.861. Satisfactory values of fit measures were obtained for a five-factor structure (RMSEA < 0.01; CFI > 0.99). The loadings of each item were statistically significant (p < 0.001). The MLHFQ score correlated significantly (p < 0.001) and positively (r > 0) with the score on the scales of physical symptoms (r = 0.479), physical limitations (r = 0.662), social limitations (r = 0.597), emotional impact (r = 0.638), and overall QoL (r = 0.712). Conclusions: Patients with severe AS exhibit low QoL. The TASQ has very good psychometric properties and can be used to assess the QoL in the population of Polish patients with AS.

Investigating the results of transcatheter aortic valve implantation (TAVI) in non-diabetic and diabetic patients: a systematic review and meta-analysis

BACKGROUND

Transcatheter aortic valve implantation (TAVI) has emerged as an effective treatment option for patients with severe aortic stenosis, particularly in those who are not suitable candidates for open-heart surgery. While diabetes is known to be associated with a higher risk of cardiovascular diseases, the impact of diabetes on the outcomes of TAVI remains controversial.

METHODS

A systematic literature search was conducted across major databases, including PubMed, Web of Science (WOS), and Google Scholar, for studies published in English over the past 20 years, up until July 2024.

RESULTS

A total of 10 observational studies were analyzed, revealing that diabetic patients were generally younger than non-diabetic patients. The 30-day mortality rate was lower in non-diabetics (0.03 [0.02-0.04]) compared to diabetics (0.04 [0.03-0.05]). However, the hazard ratio for death beyond 30 days in diabetics was 2.05 (95% CI: 0.91-4.60, p = 0.08), and at one year, it was 1.04 (95% CI: 0.78-1.39, p = 0.77), with neither result reaching statistical significance. Meta-regression analysis showed that non-insulin-treated diabetes was significantly associated with an increased risk of acute kidney injury (AKI) compared to non-diabetics, with a log odds ratio (LogOR) of 0.3393 (p = 0.035) in one analysis and 0.3166 (p = 0.028) in another, confirming a statistically significant increase in AKI risk.

CONCLUSIONS

This review highlights that while diabetes slightly increases short-term mortality after TAVI, long-term survival remains comparable to non-diabetic patients. However, non-insulin-treated diabetes significantly raises the risk of acute kidney injury (AKI), emphasizing the need for enhanced renal protection and perioperative management.

CLINICAL TRIAL NUMBER

Not applicable.

Impact of hypotonic hyponatremia on outcomes in patients undergoing transcatheter aortic valve replacement: a national inpatient sample

BACKGROUND

Transcatheter aortic valve replacement (TAVR) has emerged as a major therapeutic option for treating aortic stenosis. Hyponatremia is a common electrolyte disorder closely associated with adverse cardiovascular outcomes. However, large-scale studies investigating the impact of hypotonic hyponatremia on outcomes among TAVR patients are lacking.

METHODS

We queried patients who underwent TAVR with concomitant hypo-osmolar hyponatremia (defined as a serum sodium concentration < 135 mEq/L with a serum osmolality < 280 mOsm/kg) using the National Inpatient Sample (2016-2021). Multivariate regression analysis and 1:1 propensity score matching (PSM) were performed to assess the associations between hypo-osmolar hyponatremia and in-hospital mortality and major adverse events (including acute kidney injury [AKI], acute myocardial infarction [AMI], and cardiogenic shock [CS]). Furthermore, sensitivity analysis was performed to assess the robustness of the findings.

RESULTS

Among the total weighted national estimate of 370,680 patients who underwent TAVR, 13,865 (3.7%) had concomitant hypo-osmolar hyponatremia. These patients had a significantly increased risk of in-hospital mortality (aOR: 1.37; 95% CI: 1.08-1.74) and a greater likelihood of developing AKI (aOR: 3.39; 95% CI: 3.07-3.74), AMI (aOR: 3.20; 95% CI: 2.77-3.70), and CS (aOR: 2.96; 95% CI: 2.52-3.47). After PSM and sensitivity analysis, these associations remained significant.

CONCLUSION

In TAVR patients, hypo-osmolar hyponatremia is associated with increased in-hospital mortality and adverse events, including AKI, AMI, and CS.