Structural heart : the journal of the Heart Team · 2025
Impact of Prior Q-Wave Myocardial Infarction in Transcatheter Aortic Valve Replacement Patients With Reduced Ejection Fraction.
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Mengi Siddhartha, Urena Marina, Veiga-Fernandez Gabriela, Alperi Alberto, Nombela-Franco Luis, Vilalta Victoria, Regueiro Ander, Mesnier Jules, Fradejas-Sastre Victor, Avanzas Pablo, Lozada Ricardo Ortiz, de Oliveira-Cañedo Elena, Occhipinti Giovanni, Cepas-Guillén Pedro, Avvedimento Marisa, Rodés-Cabau Josep
Аннотация
BACKGROUND: Coronary artery disease is prevalent in transcatheter aortic valve replacement (TAVR) patients, but the specific impact of prior Q-wave myocardial infarction (QWMI), a marker of transmural infarction, remains underexplored. This study evaluated the clinical impact of QWMI in TAVR patients with left ventricular ejection fraction (LVEF) < 50%.
METHODS: Multicenter study including 1172 consecutive patients undergoing TAVR with contemporary devices, stratified according to prior QWMI. The primary outcome was all-cause mortality or heart failure hospitalization (HFH) over a median follow-up of 3 (1-4) years. Secondary endpoints included changes in LVEF and independent predictors of adverse outcomes.
RESULTS: Prior QWMI was present in 106 (9.0%) patients. Those with QWMI were younger (77.3 vs 80.6 years; p < 0.001) and had lower baseline LVEF (36.3 vs. 38.3%; p = 0.048). Unadjusted analysis showed higher all-cause mortality (49.1 vs 31.7%; p < 0.001) and combined death or HFH (54.8 vs 36.7%; p < 0.001). LVEF improvement at 30 days was attenuated in QWMI patients, particularly with anterior MI. After adjustment, QWMI was not independently associated with mortality or combined death/HFH. Chronic kidney disease (hazard ratio: 1.26; p = 0.042) and permanent atrial fibrillation (hazard ratio: 1.30; p = 0.013) were independent predictors of adverse outcomes.
CONCLUSIONS: Up to 1 out of 10 TAVR patients with reduced LVEF had prior QWMI, which was associated with impaired LVEF recovery, especially in those with anterior QWMI, and worse clinical outcomes at 3-year follow-up, largely driven by comorbidities. These findings underscore the importance of advanced preprocedural imaging, tailored therapeutic strategies, and integrated multidisciplinary care to enhance outcomes in this high-risk TAVR population.
METHODS: Multicenter study including 1172 consecutive patients undergoing TAVR with contemporary devices, stratified according to prior QWMI. The primary outcome was all-cause mortality or heart failure hospitalization (HFH) over a median follow-up of 3 (1-4) years. Secondary endpoints included changes in LVEF and independent predictors of adverse outcomes.
RESULTS: Prior QWMI was present in 106 (9.0%) patients. Those with QWMI were younger (77.3 vs 80.6 years; p < 0.001) and had lower baseline LVEF (36.3 vs. 38.3%; p = 0.048). Unadjusted analysis showed higher all-cause mortality (49.1 vs 31.7%; p < 0.001) and combined death or HFH (54.8 vs 36.7%; p < 0.001). LVEF improvement at 30 days was attenuated in QWMI patients, particularly with anterior MI. After adjustment, QWMI was not independently associated with mortality or combined death/HFH. Chronic kidney disease (hazard ratio: 1.26; p = 0.042) and permanent atrial fibrillation (hazard ratio: 1.30; p = 0.013) were independent predictors of adverse outcomes.
CONCLUSIONS: Up to 1 out of 10 TAVR patients with reduced LVEF had prior QWMI, which was associated with impaired LVEF recovery, especially in those with anterior QWMI, and worse clinical outcomes at 3-year follow-up, largely driven by comorbidities. These findings underscore the importance of advanced preprocedural imaging, tailored therapeutic strategies, and integrated multidisciplinary care to enhance outcomes in this high-risk TAVR population.