Impact of New York Heart Association Functional Class on Outcomes After Transcatheter Aortic Valve Implantation

• Published in: Cardiovascular revascularization medicine Vol. 38; pp. 19 - 26
• Main Authors: Taniguchi, Tomohiko, Shirai, Shinichi, Ando, Kenji, Arai, Yoshio, Soga, Yoshiharu, Hayashi, Masaomi, Isotani, Akihiro, Tada, Norio, Watanabe, Yusuke, Naganuma, Toru, Yamanaka, Futoshi, Yamawaki, Masahiro, Mizutani, Kazuki, Tabata, Minoru, Ueno, Hiroshi, Kuwabara, Kensuke, Takagi, Kensuke, Yashima, Fumiaki, Yamamoto, Masanori, Hayashida, Kentaro
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2022
• Subjects: Aortic stenosis; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - etiology; Aortic Valve Stenosis - surgery; Humans; New York; New York Heart Association functional class; Registries; Risk Factors; Transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; New York; Aortic stenosis; Transcatheter aortic valve implantation; New York Heart Association functional class
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2021.07.022

In the current guidelines, indications for transcatheter aortic valve implantation (TAVI) are expanded to include several subgroups of asymptomatic patients with severe aortic stenosis (AS), and there is a paucity of data on the prognostic impact of New York Heart Association (NYHA) functional class in patients with severe AS undergoing TAVI. Among 2588 patients enrolled in the OCEAN-TAVI registry, patients were divided into 4 groups according to baseline NYHA class (class I in 95 patients, class II in 1172 patients, class III in 1126 patients, and class IV in 195 patients). Median follow-up was 729 days. The cumulative 2-year incidence of all-cause death was significantly higher in patients with NYHA class IV and III than in those with NYHA class II and I. (30.0%, 21.3%, 13.4%, and 11.2%, respectively, P < 0.001). After adjusting confounders, NYHA class IV and III, but not NYHA class II were independently associated with higher mortality compared with NYHA class I (reference) (adjusted HR: 3.43, 95%CI: 1.83–7.15, P < 0.001; adjusted HR: 2.07, 95%CI: 1.15–4.19, P = 0.013; and adjusted HR: 1.50, 95%CI: 0.83–3.04, P = 0.19, respectively). With increasing NYHA class, there was an incremental increase of heart failure hospitalization in the effect size relative to the reference (NYHA class I). The long-term outcomes of patients with NYHA class I were better than those with NYHA class IV or III in some selected patients undergoing TAVI. •There is a paucity of data regarding clinical outcomes after transcatheter aortic valve implantation (TAVI) in asymptomatic patients with severe aortic stenosis (AS), because most of the previous studies have reported clinical outcomes after TAVI in symptomatic patients with severe AS.•The current study showed the benefits of TAVI in reducing mortality and HF hospitalization in patients with NYHA class Ⅰ compared to those with NYHA class III and IV.•Asymptomatic patients with severe AS had relatively low event rate after TAVI despite high risk for surgery.•TAVI might be a feasible treatment in asymptomatic patients with severe AS and any indication for AVR who have no anatomic contraindication to transfemoral TAVI in some selected patients.