Cardiac Damage and Clinical Outcomes in Symptomatic Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement.

In 30 seconds

This post hoc subanalysis of the multicentre, randomised LANDMARK trial examined whether updated echocardiographic cardiac-damage stages stratified outcomes after transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis. Stages were assessed in 596 patients, and the primary outcome was 1-year all-cause mortality. Mortality increased across stages, from 0% at stage 0 to 20.4% at stage 4 (log-rank P < 0.001). Stage 4 was independently associated with higher 1-year mortality, and the staging system had an area under the curve of 0.739 for predicting mortality.

Key findings

• One-year mortality was 0%, 1.1%, 4.7%, 7.2%, and 20.4% across cardiac-damage stages 0 through 4, respectively (log-rank P < 0.001).
• Stage 4 cardiac damage was independently associated with higher 1-year mortality in multivariable analysis.
• The area under the curve for predicting 1-year mortality was 0.739; mortality among patients with cumulative cardiac damage was 23.6%.

Why it matters

The findings indicate that cardiac damage extending beyond the left ventricle identifies patients with severe aortic stenosis who remain at higher risk after TAVR. Incorporating pulmonary hypertension probability into echocardiographic staging may help describe this risk more comprehensively and support prognostic assessment, while the results do not establish that staging-guided management improves outcomes.

What to keep in mind

This was a post hoc subanalysis, and cardiac-damage stages were assessed in 596 of the 768 patients randomized in the parent trial.