Less Symptom Improvement in Patients Undergoing TAVI With Concomitant COPD, Atrial Fibrillation and Heart Failure.

backgroundComorbidities like a history of chronic obstructive pulmonary disease (COPD), atrial fibrillation (AF) and heart failure (HF) can cause similar symptoms as aortic stenosis (AS). However, how they influence symptom improvement and long-term outcomes after transcatheter aortic valve implantation (TAVI) is unclear.

aimsTo study the impact of COPD, AF and HF on outcomes after TAVI.

methodsA history of COPD, AF and HF were collected in three TAVI cohorts (Groningen, Netherlands, Brescia, Italy and Bern, Switzerland). Symptom improvement was defined as ≥ 1 improvement of New York Heart Association (NYHA) functional class at 12 months, compared with baseline. Adverse events were defined as cardiovascular mortality, stroke or HF-hospitalisation at 5-year follow-up (VARC-3).

resultsThe pooled analysis included 5173 patients (mean age: 81.5 years, 49.7% women). Patients with COPD, AF or HF underwent TAVI at significantly lower mean aortic valve gradients, higher cardiac damage stage and higher NYHA-class. After adjusting for sex, NYHA-class, age, other comorbidities, flow-type and cardiac damage stage pre-TAVI, a history of COPD (Odds Ratio (OR): 1.75 (95% Confidence interval (CI): 1.10-2.75), p = 0.017) and a history of HF (1.65 (1.03-2.58), p = 0.038) were associated with no symptom improvement, while AF was not (1.12 (0.71-1.74, p = 0.629). Patients with COPD, AF or HF had higher risks of adverse events and lower survival at long-term follow-up.

conclusionsPatients with symptomatic AS and concomitant comorbidities of COPD, AF and HF, undergo TAVI at a lower severity of AS, have a higher symptomatic burden and higher cardiac damage stage before TAVI. They have a greater risk of residual symptoms, and a higher risk of long-term adverse events.