V. Obermeier(1), D.S. Westphal, MD(1,2), R. Thalmann, MD(1), G. Buglio(1), C. Fütterer, PhD(3), Hatim Seoudy, MD(4), I. Diebold, MD(6), T. Trenkwalder, MD(5), K.-L. Laugwitz, MD(1), D. Frank, MD(3), C. Kupatt, MD(1)

1. Department of Internal Medicine I (Cardiology), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany; 2. Institute of Human Genetics, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany; 3. Institute for Biostatistics and Epidemiology, Technical University of Munich, Munich, Germany; 4. Department of Internal Medicine III (Cardiology), University Hospital Schleswig-Holstein, Christian-Albrecht University of Kiel, Kiel, Germany; 5. Department of Internal Medicine (Cardiology), German Heart Center, Technical University of Munich, Munich, Germany; 6. Medical Genetics Center (MGZ), Munich, Germany

Objectives:

Aortic valve stenosis (AS) is a common condition in the elderly, with transcatheter aortic valve replacement (TAVR) now a standard treatment for high-risk patients. However, clinical outcomes vary, and some patients show limited benefit. AS leads to chronic pressure overload of the left ventricle (LV), resulting in four hypertrophic remodeling patterns. This study investigates the impact of different pre-TAVR echocardiographic LV-hypertrophy patterns on postprocedural outcomes, alongside genetic predisposition assessed through polygenic risk scores (PRS) for dilated (DCM) and hypertrophic cardiomyopathy (HCM).

Patients and Methods:

The study included 1,483 patients with severe aortic stenosis undergoing TAVR between 2014 and 2022 in two German centers. Based on LV mass index and relative wall thickness, patients were categorized into four groups: normal (N), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). A genetic subgroup analysis was performed in 540 patients to evaluate the influence of HCM-PRS and DCM-PRS on hypertrophy phenotypes.

Results:

Survival after TAVR was lowest in the EH group and significantly better in the CH group. The HCM-PRS was significantly associated with a reduced likelihood of developing EH, while no correlation was found between PRS and the CH phenotype or between DCM-PRS and any group.

Conclusion:

EH before TAVR is associated with poorer outcomes. A genetic link between HCM-PRS and EH suggests a potential role for genetic screening to identify high-risk patients and guide personalized treatment strategies.