Does TAVR Benefit Patients with Moderate Aortic Stenosis and Systolic Heart Failure?

The idea that patients with systolic heart failure (HF) and moderate aortic stenosis (AS) might derive benefit from afterload reduction with transcatheter aortic valve replacement (TAVR) was tested in a randomized trial (NCT02661451). Inclusion criteria were an ejection fraction of 20–50% and an aortic valve area of 1.0–1.5 cm². The primary composite hierarchical endpoint included death, disabling stroke, HF hospitalization, and change in the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score at 1 year.

Investigators randomly assigned 178 patients to TAVR or clinical surveillance (21% women; baseline characteristics: mean aortic valve area, 1.2 cm²; mean gradient, 19 mm Hg; mean ejection fraction, 39%). At 1 year, TAVR res…