TY - JOUR
T1 - Quantitative Fluid Overload in Severe Aortic Stenosis Refines Cardiac Damage and Associates with Worse Outcomes
AU - Halavina, Kseniya
AU - Koschutnik, Matthias
AU - Donà, Carolina
AU - Autherith, Maximilian
AU - Petric, Fabian
AU - Röckel, Anna
AU - Mascherbauer, Katharina
AU - Heitzinger, Gregor
AU - Dannenberg, Varius
AU - Hofer, Felix
AU - Winter, Max-Paul
AU - Andreas, Martin
AU - Treibel, Thomas A
AU - Goliasch, Georg
AU - Mascherbauer, Julia
AU - Hengstenberg, Christian
AU - Kammerlander, Andreas A
AU - Bartko, Philipp E
AU - Nitsche, Christian
N1 - Funding Information:
V.D.: proctor/speaker (Edwards, Abbott). M.A.: Proctor/consultant/speaker (Edwards, Abbott, Medtronic, Boston, Zoll, Abbvie), institutional research grants (Edwards, Abbott, Medtronic, LSI). C.H.: proctoring/speaker (Edwards Lifesciences, Boston Scientific), institutional research grants (Abbott, Boston Scientific, Edwards Lifesciences, Medtronic). A.A.K: research grants (Pfizer), speaker fees (Bayer, Boehringer Ingelheim), advisory board honoraria (Boehringer Ingelheim). C.N.: speaker, institutional research grants (Pfizer), advisory board honoraria (Prothena). All other authors have nothing to disclose. Conflict of interest:
Publisher Copyright:
© 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2023/7/18
Y1 - 2023/7/18
N2 - BACKGROUND: Cardiac decompensation in aortic stenosis (AS) involves extra-valvular cardiac damage and progressive fluid overload (FO). FO can be objectively quantified using bioimpedance spectroscopy.OBJECTIVES: We aimed to assess the prognostic value of FO beyond established damage markers to guide risk stratification.METHODS: Consecutive patients with severe AS scheduled for transcatheter aortic valve implantation (TAVI) underwent prospective risk assessment with bioimpedance spectroscopy and echocardiography. FO by BIS was defined as ≥1.0L (0.0L=euvolemia). The extent of cardiac damage was assessed by echocardiography according to an established staging classification. Right-sided cardiac damage (rCD) was defined as pulmonary vasculature/tricuspid/right ventricular damage. Heart failure hospitalization (HHF) and/or death served as primary endpoint.RESULTS: In total, 880 patients (81±7y/o, 47% female) undergoing TAVI were included. 360 (41%) had FO. Clinical examination in patients with FO was unremarkable for congestion signs in >50%. A quarter had FO but no rCD (FO+/rCD-). FO+/rCD+ had the highest damage markers, including NT-proBNP levels. After 2.4±1.0 years of follow-up, 236 patients (27%) had reached the primary endpoint (29 HHF, 194 deaths, 13 both). Quantitatively, every 1.0L increase in bioimpedance was associated with a 13% increase in event hazard (adjHR 1.13, 95% CI 1.06-1.22, P<0.001). FO provided incremental prognostic value to traditional risk markers (NT-proBNP, EuroSCORE-II, damage on echocardiography). Stratification according to FO and rCD yielded worse outcomes for FO+/rCD+ and FO+/rCD-, but not FO-/rCD+, compared to FO-/rCD-.CONCLUSION: Quantitative FO in patients with severe AS improves risk prediction of worse post-interventional outcomes compared to traditional risk assessment. This article is protected by copyright. All rights reserved.
AB - BACKGROUND: Cardiac decompensation in aortic stenosis (AS) involves extra-valvular cardiac damage and progressive fluid overload (FO). FO can be objectively quantified using bioimpedance spectroscopy.OBJECTIVES: We aimed to assess the prognostic value of FO beyond established damage markers to guide risk stratification.METHODS: Consecutive patients with severe AS scheduled for transcatheter aortic valve implantation (TAVI) underwent prospective risk assessment with bioimpedance spectroscopy and echocardiography. FO by BIS was defined as ≥1.0L (0.0L=euvolemia). The extent of cardiac damage was assessed by echocardiography according to an established staging classification. Right-sided cardiac damage (rCD) was defined as pulmonary vasculature/tricuspid/right ventricular damage. Heart failure hospitalization (HHF) and/or death served as primary endpoint.RESULTS: In total, 880 patients (81±7y/o, 47% female) undergoing TAVI were included. 360 (41%) had FO. Clinical examination in patients with FO was unremarkable for congestion signs in >50%. A quarter had FO but no rCD (FO+/rCD-). FO+/rCD+ had the highest damage markers, including NT-proBNP levels. After 2.4±1.0 years of follow-up, 236 patients (27%) had reached the primary endpoint (29 HHF, 194 deaths, 13 both). Quantitatively, every 1.0L increase in bioimpedance was associated with a 13% increase in event hazard (adjHR 1.13, 95% CI 1.06-1.22, P<0.001). FO provided incremental prognostic value to traditional risk markers (NT-proBNP, EuroSCORE-II, damage on echocardiography). Stratification according to FO and rCD yielded worse outcomes for FO+/rCD+ and FO+/rCD-, but not FO-/rCD+, compared to FO-/rCD-.CONCLUSION: Quantitative FO in patients with severe AS improves risk prediction of worse post-interventional outcomes compared to traditional risk assessment. This article is protected by copyright. All rights reserved.
UR - http://www.scopus.com/inward/record.url?scp=85165684988&partnerID=8YFLogxK
U2 - 10.1002/ejhf.2969
DO - 10.1002/ejhf.2969
M3 - Journal article
C2 - 37462329
SN - 1388-9842
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
ER -