Findings from the TAVR UNLOAD study found limited benefits of transcatheter aortic valve replacement (TAVR) in the treatment of heart failure (HF) with reduced ejection fraction (HFrEF) and moderate aortic stenosis (AS). Findings were reported today at TCT 2024 , the annual scientific symposium of the Cardiovascular Research Foundation (CRF). The results were also published in the Journal of the American College of Cardiology.
Medical neurohormonal modulation and afterload reduction are key elements in the treatment of HFrEF. In patients with HFrEF and moderate AS, a complementary target for afterload reduction may be treatment of AS. However, current guidelines recommend TAVR for symptomatic severe AS or for asymptomatic severe AS with left ventricular (LV) ejection fraction 1.
0 cm 2 and ≤1.5 cm 2 ) who were suitable for transfemoral TAVR with a balloon-expandable valve. From January 2017 to December 2022, 178 patients at 66 institutions in the United States, Netherlands and Austria were randomized 1:1 to TAVR and guideline-directed medical therapy (n=89) or guideline-directed medical therapy alone (n=89).
The mean age of participants was 77 years, 20.8% were female and 55.6% were in NYHA class III or IV.
The mean LV ejection fraction was 39%. During the study, 39% (n=35) of those in the medical therapy group progressed from moderate to severe AS. The original study design required 600 patients (two groups of 300) with a primary endpoint analysis at one year.
However, an u.
