Journal
JACC-CARDIOVASCULAR INTERVENTIONS
Volume 12, Issue 4, Pages 373-382Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcin.2018.11.013
Keywords
aortic stenosis; left ventricular hypertrophy; transcatheter aortic valve replacement
Categories
Funding
- American College of Cardiology Foundation's National Cardiovascular Data Registry
- Society of Thoracic Surgeons
- American College of Cardiology
- Patient-Centered Outcomes Research Institute
- Boston Scientific
- Abbott Vascular
- Medtronic
- Abiomed
- Cardiovascular Systems Inc.
- CathWorks
- Siemens
- Philips
- ReCor Medical
- VA Office of Research and Development [iK2CX001074]
- Siemens Medical Solutions
- National Institutes of Health [5 T32 HL069749-14]
- American Heart Association
- St. Jude Medical
- Abbott
- Cleveland Clinic
- Duke Clinical Research Institute
- Mayo Clinic
- Mount Sinai School of Medicine
- Population Health Research Institute
- Boehringer Ingelheim
- Bayer
- Amarin
- Amgen
- AstraZeneca
- Bristol-Myers Squibb
- Chiesi
- Eisai
- Ethicon
- Forest Laboratories
- Idorsia
- Ironwood
- Ischemix
- Lilly
- PhaseBio
- Pfizer
- Regeneron
- Roche
- Sanofi
- Synaptic
- Medicines Company
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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. (J Am Coll Cardiol Intv 2019;12:373-82) (c) 2019 by the American College of Cardiology Foundation.
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