Abstract
BACKGROUND: The impact of cardiometabolic factors, such as atherogenic lipids, on hemodynamic valve deterioration (HVD) after transcatheter aortic valve replacement (TAVR) has not been studied. OBJECTIVES: The objective of the study was to investigate the association between cardiometabolic factors and HVD in patients following TAVR. METHODS: The UC San Diego Health internal Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry was used to identify patients who underwent TAVR from May 2013 to December 2022 with echocardiographic follow-up. The primary outcome was moderate or severe HVD, defined by Valve Academic Research Consortium 3 guidelines, with all-cause death treated as a competing risk. RESULTS: A total of 555 patients (median age 81 years, 38.7% female, 32.3% diabetes, median lipoprotein(a) 17 mg/dL, 52.8% with low-density lipoprotein >70 mg/dL) were included. Most patients were on statins (74.8%), whereas few were on other cardiometabolic therapies. HVD occurred in 6.3% of patients at a median of 3.7 years. The cumulative incidence of HVD was higher in patients with elevated triglycerides (>100 mg/dL) (HR: 3.81; 95% CI: 1.75-8.29; P < 0.001) and remnant cholesterol (HR: 1.03; 95% CI: 1.02-1.04; P < 0.001). Elevated triglycerides were associated with a higher annualized rate of change in peak aortic jet velocity (0.01 m/s/y, IQR: -0.07-0.18, vs -0.02 m/s/y, IQR: -0.13-0.09; P = 0.027). HVD was not associated with other cardiometabolic factors. CONCLUSIONS: Elevated triglycerides and remnant cholesterol were associated with a higher cumulative incidence of HVD, and elevated triglycerides were associated with a higher annualized rate of change in peak aortic jet velocity. Optimizing cardiometabolic risk factors may be a strategy for improving TAVR valve longevity that warrants future study.