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

Background: 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.

Aims: To study the impact of COPD, AF and HF on outcomes after TAVI.

Methods: 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).

Results: 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.

Conclusions: 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.