van Bergeijk Kees H, Venema Constantijn S, Ophuis Bob, Plekkenpol Luca H, Tomei Mara, Al-Barwary Hayman, Tromp Jasper, Hummel Yoran M, Ouwerkerk Wouter, van den Heuvel Ad F M, van der Werf Hindrik W, Douglas Yvonne L, Lanz Jonas, Stortecky Stefan, Tomii Daijiro, Pilgrim Thomas, Windecker Stephan, Pancaldi Edoardo, Pagnesi Matteo, Adamo Marianna, Voors Adriaan A, Wykrzykowska Joanna J
Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
Saw Swee Hock School of Public Health, National University of Singapore, and the National University Health System, Singapore, Singapore.
Catheter Cardiovasc Interv. 2025 Sep;106(3):1828-1836. doi: 10.1002/ccd.70003. Epub 2025 Jul 11.
Comorbidities 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.
To study the impact of COPD, AF and HF on outcomes after TAVI.
A 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).
The 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.
Patients 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.
慢性阻塞性肺疾病（COPD）、心房颤动（AF）和心力衰竭（HF）等合并症可导致与主动脉瓣狭窄（AS）相似的症状。然而，它们如何影响经导管主动脉瓣植入术（TAVI）后的症状改善和长期预后尚不清楚。
研究COPD、AF和HF对TAVI术后预后的影响。
在三个TAVI队列（荷兰格罗宁根、意大利布雷西亚和瑞士伯尔尼）中收集COPD、AF和HF病史。症状改善定义为与基线相比，12个月时纽约心脏协会（NYHA）功能分级改善≥1级。不良事件定义为5年随访（VARC-3）时的心血管死亡、中风或心力衰竭住院。
汇总分析包括5173例患者（平均年龄：81.5岁，49.7%为女性）。患有COPD、AF或HF的患者接受TAVI时，平均主动脉瓣梯度显著更低，心脏损伤阶段更高，NYHA分级更高。在对性别、NYHA分级、年龄、其他合并症、血流类型和TAVI术前心脏损伤阶段进行调整后，COPD病史（优势比（OR）：1.75（95%置信区间（CI）：1.10-2.75），p = 0.017）和HF病史（1.65（1.03-2.58），p = 0.038）与症状无改善相关，而AF则不然（1.12（0.71-1.74，p = 0.629）。患有COPD、AF或HF的患者长期随访时不良事件风险更高，生存率更低。
有症状的AS合并COPD、AF和HF合并症的患者，AS严重程度较低时接受TAVI，TAVI术前症状负担更高，心脏损伤阶段更高。他们残留症状的风险更大，长期不良事件风险更高。
