Validation of the Cardiac Damage Classification and Additional Effects of Albumin Levels in a Large Cohort of Patients Undergoing Transcatheter Aortic Valve Replacement - The 66th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery

Anat Berkovitch ^1,2 Israel M. Barbash ^1,2 Ariel Finkelstein ^2,3 Abid R Assali ^2,4 Haim Denenberg ⁵ Paul Fefer ^1,2 Elad Maor ^1,2 Sophia Zhitomirsky ^2,3 Katia Orvin ^2,4 Arik Steinvil ^2,3 Alon Barsheshet ^2,4 Amir Halkin ^2,3 Victor Guetta ^1,2 Ran Kornowski ^2,4 Amit Segev ^1,2

¹Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center
²Sackler School of Medicine, Tel-Aviv University
³Division of Cardiology, Tel Aviv Medical Center
⁴Division of Cardiology, Rabin Medical Center
⁵The Heart Institute, Hadassah Ein-Karem Medical Center, The Hebrew University

Background: Risk stratification in patients undergoing transcatheter aortic valve replacement (TAVR) is limited and based on clinical judgment and surgical AVR scoring systems. Recently, extent of cardiac damage using an echocardiographic classification was purposed to assess prognosis of patients undergoing TAVR. We aimed to validate this new scoring system in a real-world cohort and to examine the addition of baseline albumin in risk assessment.

Methods: We investigated 2,608 patients undergoing TAVR. All subjects had an echocardiography test prior to TAVR. Subjects were divided into five groups based on their echocardiography findings: stage 0 – 758 (29%) patients, stage 1 – 769 (30%), stage 2 – 730 (28%), stage 3 – 320 (12%) and stage 4 (1.2%). Patients were further assessed by incorporating baseline albumin.

Results: Mean age of study population was 82±7 years. Kaplan-Meier’s survival analysis showed that the cumulative probability of mortality was significantly higher among subjects with increased stage compared to the lower stages (p<0.001). Multivariable analysis demonstrated that each increase in stage was associated with significant increased risk of 1-year mortality (HR 1.33, 95%CI 1.18-1.50, p<0.001). Among patients at increased stage (3-4), incorporation of baseline of albumin identified the highest risk group, such that each 1 decrement in albumin levels was associated with more than triple increase in mortality among patients at stage 3 and 4 (HR 3.37, 95%CI 1.7-6.5, p-value<0.001). When added to the scoring risk prediction model, albumin allowed more accurate risk stratification: continuous NRI analysis showed an overall improvement of 11% (95% CI 6%-16%) in the accuracy of classification.

Conclusions: Cardiac damage classification is validated in a real-world cohort of patients undergoing TAVR. Incorporation of low baseline albumin may further identify patients at the highest risk group.