Three-year-survival analysis after TAVI in different subtypes of aortic stenosis and impact of mental co-morbidities

Background: Survival in aortic stenosis (AS) patients after TAVI is difficult to predict, since typical patients are frail and suffer from various co-morbidities. Among others, subtype of AS (high-gradient – HGAS; low-gradient – LGAS; paradoxical low-flow low-gradient – PLFLGAS) as well as the presence of mental disorders at baseline have been shown to impact patients’ long-term survival. The current study was aimed to analyze three-year survival after TAVI in different AS subtypes as well as the impact of baseline depression and anxiety in each subtype in a large prospective single-center registry.

Methods and Results: From the local aortic valve registry at the University Hospital Jena (Jenaer Aortenklappenregister, JAKR), a total of 490 patients (mean age: 79 ± 7 years; 50% female; mean STS score 4.6 ± 3.6%) that underwent transfemoral TAVI were subjected to this study. Patients were classified at baseline according to AS subtype (HGAS, 73%; LGAS, 16%; PLFLGAS, 11%) and the presence of mental co-morbidities, assessed using the Hospital Anxiety and Depression Scale (HADS-D) with a cut-off value of 8 points for depression / anxiety, in the whole collective (depression: 26%, n=129; anxiety: 29%, n=143) and per subtype (HGAS: depression: 24%, anxiety: 28%; LGAS: depression: 36%, anxiety: 33%; PLFLGAS: depression: 31%, anxiety: 33%). While there were no differences with respect to the presence of anxiety between the subtypes (p=n.s.), the depression rate in LGAS patients was significantly higher compared to HGAS patients (p=0.024). Kaplan-Meier analysis revealed a three-year survival of 73% in HGAS, of 50% in LGAS and of 59% in PLFLGAS patients (p<0.001) within the whole collective. In patients with depression, the three-year survival rate was 58% compared to 71% in patients without depression (p=0.003). In contrast, patients with and without anxiety did not show differences in three-year survival (p=0.913). In the subgroup of HGAS patients, a significantly decreased three-year survival rate could be observed in patients with (61%) compared to patients without depression (77%, p=0.004). In contrast, there were no differences in survival between patients with and without anxiety in this subgroup (p=0.493). In the subgroups of LGAS and PLFLGAS patients, there were no differences in three-year survival between patients with and without both, depression and anxiety (p=n.s.).

Conclusion: This is the first study focusing on the relationship between AS subtype and mental-comorbidities at baseline with respect to long-term survival after TAVI. Most notably, the impact of depression for long-term survival was only observable in HGAS but not in LGAS and PLFLGAS patients. Thus, the latter patients might present in later stages of the cardiovascular disease continuum predicting worse outcomes itself, while outcomes in HGAS patients could possibly be determined by non-cardiac diseases or depression itself.