PMID- 34810275 OWN - NLM STAT- MEDLINE DCOM- 20220202 LR - 20220202 IS - 2053-3624 (Print) IS - 2053-3624 (Electronic) IS - 2053-3624 (Linking) VI - 8 IP - 2 DP - 2021 Nov TI - Predictors and clinical outcomes of poor symptomatic improvement after transcatheter aortic valve replacement. LID - 10.1136/openhrt-2021-001742 [doi] LID - e001742 AB - OBJECTIVE: Transcatheter aortic valve replacement (TAVR) improves clinical symptoms in most patients with severe aortic stenosis (AS). However, some patients do not benefit from the symptom-reducing effects of TAVR. We assessed the predictors and clinical outcomes of poor symptomatic improvement (SI) after TAVR. METHODS: A total of 1749 patients with severe symptomatic AS undergoing transfemoral TAVR were evaluated using the Japanese multicentre TAVR registry. Poor SI was defined as readmission for heart failure (HF) within 1 year after TAVR or New York Heart Association (NYHA) class >/=3 after 1 year. A logistic regression model was used to identify predictors of poor SI. One-year landmark analysis after TAVR was used to evaluate the association between poor SI and clinical outcomes. RESULTS: Among the overall population (mean age, 84.5 years; female, 71.3%; mean STS score, 6.3%), 6.6% were categorised as having poor SI. Atrial fibrillation, chronic obstructive pulmonary disease, Clinical Frailty Scale >/=4, chronic kidney disease and moderate to severe mitral regurgitation were independent predictors of poor SI. One-year landmark analysis demonstrated that poor SI had a higher incidence of all-cause death and readmission for HF compared with SI (p<0.001). Poor SI with preprocedural NYHA class 2 had a worse outcome than SI with preprocedural NYHA class >/=3. CONCLUSIONS: Poor SI was associated with worse outcomes 1 year after the procedure. It had a greater impact on clinical outcomes than baseline symptoms. TAVR may be challenging for patients with many predictors of poor SI. TRIAL REGISTRATION NUMBER: This registry, associated with the University Hospital Medical Information Network Clinical Trials Registry, was accepted by the International Committee of Medical Journal Editors (UMIN-ID: 000020423). CI - (c) Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Yoshijima, Nobuhiro AU - Yoshijima N AUID- ORCID: 0000-0002-5849-4627 AD - Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. FAU - Saito, Tetsuya AU - Saito T AUID- ORCID: 0000-0001-5356-9477 AD - Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. FAU - Inohara, Taku AU - Inohara T AD - Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. FAU - Anzai, Atsushi AU - Anzai A AD - Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. FAU - Tsuruta, Hikaru AU - Tsuruta H AD - Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. FAU - Shimizu, Hideyuki AU - Shimizu H AD - Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan. FAU - Fukuda, Keiichi AU - Fukuda K AD - Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. FAU - Naganuma, Toru AU - Naganuma T AD - Department of Cardiology, New Tokyo Hospital, Matsudo, Japan. FAU - Mizutani, Kazuki AU - Mizutani K AD - Department of Cardiology, Osaka City General Hospital, Osaka, Japan. FAU - Yamawaki, Masahiro AU - Yamawaki M AD - Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan. FAU - Tada, Norio AU - Tada N AD - Department of Cardiology, Sendai Kousei Hospital, Sendai, Japan. FAU - Yamanaka, Futoshi AU - Yamanaka F AD - Department of Cardiology, Shonankamakura General Hospital, Kamakura, Japan. FAU - Shirai, Shinichi AU - Shirai S AD - Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan. FAU - Tabata, Minoru AU - Tabata M AD - Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan. FAU - Ueno, Hiroshi AU - Ueno H AD - Department of Cardiology, Toyama University Hospital, Toyama, Japan. FAU - Takagi, Kensuke AU - Takagi K AD - Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan. FAU - Watanabe, Yusuke AU - Watanabe Y AUID- ORCID: 0000-0003-2297-5303 AD - Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan. FAU - Yamamoto, Masanori AU - Yamamoto M AUID- ORCID: 0000-0001-5210-6382 AD - Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan. AD - Department of Cardiology, Nagoya Heart Center, Nagoya, Japan. FAU - Hayashida, Kentaro AU - Hayashida K AD - Department of Cardiology, Keio University School of Medicine, Tokyo, Japan k-hayashida@umin.ac.jp. CN - OCEAN-TAVI investigators LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't PL - England TA - Open Heart JT - Open heart JID - 101631219 SB - IM MH - Aortic Valve/*surgery MH - Aortic Valve Stenosis/complications/diagnosis/*surgery MH - Cause of Death/trends MH - Echocardiography MH - Heart Failure/*epidemiology/etiology MH - Humans MH - Incidence MH - Japan/epidemiology MH - Prospective Studies MH - *Registries MH - Risk Factors MH - Severity of Illness Index MH - Survival Rate/trends MH - Transcatheter Aortic Valve Replacement/*methods PMC - PMC8609939 OTO - NOTNLM OT - aortic valve stenosis OT - heart failure OT - transcatheter aortic valve replacement COIS- Competing interests: MY, NT, TN, SS, KM, MT, HU, YW and KH are clinical proctors for Edwards Lifesciences and Medtronic. HS and KT are clinical proctors for Edwards Lifesciences. EDAT- 2021/11/24 06:00 MHDA- 2022/02/03 06:00 PMCR- 2021/11/22 CRDT- 2021/11/23 05:54 PHST- 2021/06/02 00:00 [received] PHST- 2021/10/08 00:00 [accepted] PHST- 2021/11/23 05:54 [entrez] PHST- 2021/11/24 06:00 [pubmed] PHST- 2022/02/03 06:00 [medline] PHST- 2021/11/22 00:00 [pmc-release] AID - openhrt-2021-001742 [pii] AID - 10.1136/openhrt-2021-001742 [doi] PST - ppublish SO - Open Heart. 2021 Nov;8(2):e001742. doi: 10.1136/openhrt-2021-001742.