JACC. Cardiovascular interventions · 2026
Clinical Application of Guideline-Directed Medical Therapy in TAVR Patients With Heart Failure and Reduced Ejection Fraction.
СтатьяНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Kobari Yusuke, Maznyczka Annette, Khokhar Arif A, Sørensen Louise Marqvard, Lulic Davorka, Bieliauskas Gintautas, Raja Anna Axelsson, Ersbøll Mads Kristian, Rossing Kasper, Gustafsson Finn, Køber Lars, Prendergast Bernard, Fosbøl Emil, De Backer Ole
Аннотация
BACKGROUND: There are limited data concerning the impact of heart failure (HF) guideline-directed medical therapy (GDMT) in patients with HF with reduced ejection fraction (HFrEF) who undergo transcatheter aortic valve replacement (TAVR).
OBJECTIVES: The aims of this study were to determine whether TAVR patients with HFrEF receive optimal HF-GDMT and to investigate the prognostic significance of HF-GDMT in this setting.
METHODS: In a prospective registry, consecutive TAVR patients with HFrEF were stratified into 4 groups (quadruple, triple, double, or single or no therapy) according to prescription of HF-GDMT at discharge post-TAVR and after a 3-month GDMT optimization period. Major adverse cardiovascular events (MACE) were defined as a composite of cardiovascular mortality or hospitalization for heart failure. The median follow-up time was 699 days (Q1-Q3: 510-961 days).
RESULTS: Among 336 TAVR patients with HFrEF, the rates of quadruple, triple, double, and single or no HF-GDMT were 15%, 19%, 28%, and 38% at discharge and 27%, 21%, 21%, and 27% at 3 months postprocedure, respectively. Among 280 patients (83.3%) eligible for quadruple HF-GDMT, only 27% (n = 76) received this combination at 3 months post-TAVR. Following a 3-month HF-GDMT optimization period, 2-year MACE rates were lower in patients taking quadruple (15.0%; 95% CI: 5.2%-24.8%) compared with triple (22.6%; 95% CI: 10.4%-34.8%), double (24.2%; 95% CI: 13.8%-34.6%), and single or no therapy (43.6%; 95% CI: 31.8%-55.4%; log-rank P < 0.001).
CONCLUSIONS: HF-GDMT is underused in patients with HFrEF who undergo TAVR, and suboptimal HF-GDMT is associated with increased MACE in this setting. Strategies to improve the initiation and up-titration of HF-GDMT in TAVR patients with HFrEF are needed.
OBJECTIVES: The aims of this study were to determine whether TAVR patients with HFrEF receive optimal HF-GDMT and to investigate the prognostic significance of HF-GDMT in this setting.
METHODS: In a prospective registry, consecutive TAVR patients with HFrEF were stratified into 4 groups (quadruple, triple, double, or single or no therapy) according to prescription of HF-GDMT at discharge post-TAVR and after a 3-month GDMT optimization period. Major adverse cardiovascular events (MACE) were defined as a composite of cardiovascular mortality or hospitalization for heart failure. The median follow-up time was 699 days (Q1-Q3: 510-961 days).
RESULTS: Among 336 TAVR patients with HFrEF, the rates of quadruple, triple, double, and single or no HF-GDMT were 15%, 19%, 28%, and 38% at discharge and 27%, 21%, 21%, and 27% at 3 months postprocedure, respectively. Among 280 patients (83.3%) eligible for quadruple HF-GDMT, only 27% (n = 76) received this combination at 3 months post-TAVR. Following a 3-month HF-GDMT optimization period, 2-year MACE rates were lower in patients taking quadruple (15.0%; 95% CI: 5.2%-24.8%) compared with triple (22.6%; 95% CI: 10.4%-34.8%), double (24.2%; 95% CI: 13.8%-34.6%), and single or no therapy (43.6%; 95% CI: 31.8%-55.4%; log-rank P < 0.001).
CONCLUSIONS: HF-GDMT is underused in patients with HFrEF who undergo TAVR, and suboptimal HF-GDMT is associated with increased MACE in this setting. Strategies to improve the initiation and up-titration of HF-GDMT in TAVR patients with HFrEF are needed.
Предметные рубрики MeSH
HumansStroke VolumeHeart FailureMaleFemaleTranscatheter Aortic Valve ReplacementRegistriesAged, 80 and overAgedProspective StudiesTreatment OutcomeTime FactorsVentricular Function, LeftAortic Valve StenosisPractice Guidelines as TopicRisk FactorsGuideline AdherenceCardiovascular AgentsAortic ValvePractice Patterns, Physicians'Recovery of FunctionKaplan-Meier Estimate