{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T08:31:06Z","timestamp":1789115466934,"version":"build-2803163510"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011797","name":"Turku University Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100011797","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>This study aims to assess the changes in cardiac damage stage in a real-world cohort of patients undergoing transcatheter aortic valve implantation (TAVI), and to investigate the prognostic value of cardiac damage stage evolution.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Patients with severe aortic stenosis (AS) undergoing TAVI were retrospectively analysed. A five-stage system based on the presence and extent of cardiac damage assessed by echocardiography was applied before and 6 months after TAVI. Multivariable Cox regression analyses were used to examine independent prognostic value of the changes in cardiac damage after TAVI. A total of 734 patients with severe AS (mean age, 79.8 \u00b1 7.4 years; 55% male) were included. Before TAVI, 32 (4%) patients did not show any sign of extra-valvular cardiac damage (Stage 0), 85 (12%) had left ventricular damage (Stage 1), 220 (30%) left atrial and\/or mitral valve damage (Stage 2), 227 (31%) pulmonary vasculature and\/or tricuspid valve damage (Stage 3), and 170 (23%) right ventricular damage (Stage 4). Six months after TAVI, 39% of the patients improved at least one stage in cardiac damage. Staging of cardiac damage at 6 months after TAVI [hazard ratio (HR) per one-stage increase, 1.391; P = 0.035] as well as worsening in the stage of cardiac damage (HR, 3.729; P = 0.005) were independently associated with 2-year all-cause mortality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>More than one-third of patients with severe AS showed an improvement in cardiac damage 6 months after TAVI. Staging cardiac damage at baseline and follow-up may improve risk stratification in patients undergoing TAVI.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaf045","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T17:31:33Z","timestamp":1738690293000},"page":"918-927","source":"Crossref","is-referenced-by-count":5,"title":["The reversibility of cardiac damage after transcatheter aortic valve implantation and short-term outcomes in a real-world setting"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6544-1777","authenticated-orcid":false,"given":"Rinchyenkhand","family":"Myagmardorj","sequence":"first","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]},{"name":"Department of Cardiology, Mongolian National University of Medical Sciences , Ulaanbaatar ,","place":["Mongolia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Fortuni","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]},{"name":"Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia , Perugia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"G\u00e9n\u00e9reux","sequence":"additional","affiliation":[{"name":"Gagnon Cardiovascular Institute, Morristown Medical Center , Morristown, NJ ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeru","family":"Nabeta","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9745-5498","authenticated-orcid":false,"given":"Jan","family":"Stassen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]},{"name":"Department of Cardiology, Jessa Hospital , Hasselt ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6294-7668","authenticated-orcid":false,"given":"Xavier","family":"Galloo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]},{"name":"Department of Cardiology, UZ Brussel, Vrije Universiteit Brussel , Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5474-0555","authenticated-orcid":false,"given":"Maria Chiara","family":"Meucci","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steele","family":"Butcher","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4521-8698","authenticated-orcid":false,"given":"Frank","family":"van der Kley","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Cohen","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Foundation , New York, NY ,","place":["USA"]},{"name":"St. Francis Hospital and Heart Center , Roslyn, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8924-740X","authenticated-orcid":false,"given":"Marie-Annick","family":"Clavel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Qu\u00e9bec Heart and Lung Institute - Laval University , Qu\u00e9bec ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3607-279X","authenticated-orcid":false,"given":"Philippe","family":"Pibarot","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Qu\u00e9bec Heart and Lung Institute - Laval University , Qu\u00e9bec ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin B","family":"Leon","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Foundation , New York, NY ,","place":["USA"]},{"name":"Division of Cardiology, NewYork-Presbyterian Hospital\/Columbia University Irving Medical Center , New York, NY ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1562-8365","authenticated-orcid":false,"given":"Madelien V","family":"Regeer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9841-2737","authenticated-orcid":false,"given":"Victoria","family":"Delgado","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Imaging, Hospital University Germans Trias i Pujol , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7208-5769","authenticated-orcid":false,"given":"Nina","family":"Ajmone Marsan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen J","family":"Bax","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Lung Center, Leiden University Medical Center , Leiden ,","place":["The Netherlands"]},{"name":"Department of Cardiology, Turku Heart Center, University of Turku and Turku University Hospital , Turku ,","place":["Finland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"2025043022555073600_jeaf045-B1","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1161\/CIRCULATIONAHA.119.043391","article-title":"Global, regional, and national burden of calcific aortic valve and degenerative mitral valve diseases, 1990\u20132017","volume":"141","author":"Yadgir","year":"2020","journal-title":"Circulation"},{"key":"2025043022555073600_jeaf045-B2","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1056\/NEJMoa1814052","article-title":"Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients","volume":"380","author":"Mack","year":"2019","journal-title":"N Engl J Med"},{"key":"2025043022555073600_jeaf045-B3","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1056\/NEJMoa1103510","article-title":"Transcatheter versus surgical aortic-valve replacement in high-risk patients","volume":"364","author":"Smith","year":"2011","journal-title":"N Engl J Med"},{"key":"2025043022555073600_jeaf045-B4","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1056\/NEJMoa1514616","article-title":"Transcatheter or surgical aortic-valve replacement in intermediate-risk patients","volume":"374","author":"Leon","year":"2016","journal-title":"N Engl J Med"},{"key":"2025043022555073600_jeaf045-B5","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1161\/CIRCINTERVENTIONS.114.002073","article-title":"Effect of tricuspid regurgitation and the right heart on survival after transcatheter aortic valve replacement: insights from the placement of aortic transcatheter valves in inoperable cohort","volume":"8","author":"Lindman","year":"2015","journal-title":"Circ Cardiovasc Interv"},{"key":"2025043022555073600_jeaf045-B6","doi-asserted-by":"crossref","first-page":"3351","DOI":"10.1093\/eurheartj\/ehx381","article-title":"Staging classification of aortic stenosis based on the extent of cardiac damage","volume":"38","author":"G\u00e9n\u00e9reux","year":"2017","journal-title":"Eur Heart J"},{"key":"2025043022555073600_jeaf045-B7","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.jacc.2019.05.048","article-title":"Staging cardiac damage in patients with symptomatic aortic valve stenosis","volume":"74","author":"Vollema","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2025043022555073600_jeaf045-B8","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.jacc.2019.04.065","article-title":"Staging cardiac damage in patients with asymptomatic aortic valve stenosis","volume":"74","author":"Tastet","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2025043022555073600_jeaf045-B9","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1007\/s00392-021-01835-w","article-title":"Outcome of aortic stenosis according to invasive cardiac damage staging after transcatheter aortic valve replacement","volume":"110","author":"Schewel","year":"2021","journal-title":"Clin Res Cardiol"},{"key":"2025043022555073600_jeaf045-B10","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/j.jcmg.2021.11.009","article-title":"Prognostic impact of extra-mitral valve cardiac involvement in patients with primary mitral regurgitation","volume":"15","author":"Van Wijngaarden","year":"2022","journal-title":"J Am Coll Cardiol Img"},{"key":"2025043022555073600_jeaf045-B11","doi-asserted-by":"crossref","first-page":"2645","DOI":"10.1007\/s10554-022-02673-1","article-title":"Staging cardiac damage in patients with aortic regurgitation","volume":"38","author":"Silva","year":"2022","journal-title":"Int J Cardiovasc Imaging"},{"key":"2025043022555073600_jeaf045-B12","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.jacc.2022.05.006","article-title":"Evolution and prognostic impact of cardiac damage after aortic valve replacement","volume":"80","author":"G\u00e9n\u00e9reux","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2025043022555073600_jeaf045-B13","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1093\/ehjci\/jew335","article-title":"Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European association of cardiovascular imaging and the American society of echocardiography","volume":"18","author":"Baumgartner","year":"2017","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2025043022555073600_jeaf045-B14","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/ehjci\/jev014","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging","volume":"16","author":"Lang","year":"2015","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2025043022555073600_jeaf045-B15","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1093\/ehjci\/jew082","article-title":"Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American society of echocardiography and the European association of cardiovascular imaging","volume":"17","author":"Nagueh","year":"2016","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2025043022555073600_jeaf045-B16","doi-asserted-by":"crossref","first-page":"e171","DOI":"10.1093\/ehjci\/jeab253","article-title":"Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC council of valvular heart disease position paper","volume":"23","author":"Lancellotti","year":"2022","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2025043022555073600_jeaf045-B17","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.echo.2010.05.010","article-title":"Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American society of echocardiography endorsed by the European association of echocardiography, a registered branch of the European Society of Cardiology, and the Canadian society of echocardiography","volume":"23","author":"Rudski","year":"2010","journal-title":"J Am Soc Echocardiogr"},{"key":"2025043022555073600_jeaf045-B18","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1093\/ehjqcco\/qcab041","article-title":"Refined staging classification of cardiac damage associated with aortic stenosis and outcomes after transcatheter aortic valve implantation","volume":"7","author":"Okuno","year":"2021  28","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2025043022555073600_jeaf045-B19","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s12350-019-01624-z","article-title":"Landmark analysis: a primer","volume":"26","author":"Morgan","year":"2019","journal-title":"J Nucl Cardiol"},{"key":"2025043022555073600_jeaf045-B20","first-page":"100768","article-title":"Staging cardiac damage associated with aortic stenosis in patients undergoing transcatheter aortic valve implantation","volume":"33","author":"Okuno","year":"2021","journal-title":"Int J Cardiol Heart Vasc"},{"key":"2025043022555073600_jeaf045-B21","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1093\/ehjci\/jeaa220","article-title":"Incremental value of left ventricular global longitudinal strain in a newly proposed staging classification based on cardiac damage in patients with severe aortic stenosis","volume":"21","author":"Vollema","year":"2020","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2025043022555073600_jeaf045-B22","doi-asserted-by":"crossref","first-page":"e014463","DOI":"10.1161\/JAHA.119.014463","article-title":"Prognostic assessment of right ventricular systolic dysfunction on post-transcatheter aortic valve replacement short-term outcomes: systematic review and meta-analysis","volume":"9","author":"Grevious","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2025043022555073600_jeaf045-B23","doi-asserted-by":"crossref","first-page":"3923","DOI":"10.1007\/s00330-020-07462-9","article-title":"Short-term adverse remodeling progression in asymptomatic aortic stenosis","volume":"31","author":"Singh","year":"2021","journal-title":"Eur Radiol"},{"key":"2025043022555073600_jeaf045-B24","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.echo.2020.10.014","article-title":"Left ventricular myocardial work in patients with severe aortic stenosis","volume":"34","author":"Fortuni","year":"2021","journal-title":"J Am Soc Echocardiogr"},{"key":"2025043022555073600_jeaf045-B25","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.jcmg.2024.05.010","article-title":"The need for comprehensive risk phenotyping in aortic stenosis","volume":"17","author":"Fortuni","year":"2024","journal-title":"JACC Cardiovasc Imaging"},{"key":"2025043022555073600_jeaf045-B26","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/j.cjca.2014.04.026","article-title":"Left ventricular remodelling in aortic stenosis","volume":"30","author":"Rassi","year":"2014","journal-title":"Can J Cardiol"},{"key":"2025043022555073600_jeaf045-B27","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1161\/CIRCULATIONAHA.120.050763","article-title":"Changing the paradigm in the management of valvular heart disease: in addition to left ventricular ejection fraction, focus on the myocardium","volume":"143","author":"Fortuni","year":"2021","journal-title":"Circulation"},{"key":"2025043022555073600_jeaf045-B28","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.jcmg.2018.11.026","article-title":"Imaging and impact of myocardial fibrosis in aortic stenosis","volume":"12","author":"Bing","year":"2019","journal-title":"J Am Coll Cardiol Img"},{"key":"2025043022555073600_jeaf045-B29","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1093\/ehjci\/jes102","article-title":"Diffuse myocardial fibrosis in severe aortic stenosis: an equilibrium contrast cardiovascular magnetic resonance study","volume":"13","author":"Flett","year":"2012","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2025043022555073600_jeaf045-B30","doi-asserted-by":"crossref","first-page":"1903","DOI":"10.1093\/eurheartj\/ehaa033","article-title":"Impact of myocardial fibrosis on left ventricular remodelling, recovery, and outcome after transcatheter aortic valve implantation in different haemodynamic subtypes of severe aortic stenosis","volume":"41","author":"Puls","year":"2020","journal-title":"Eur Heart J"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/advance-article-pdf\/doi\/10.1093\/ehjci\/jeaf045\/61752665\/jeaf045.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/26\/5\/918\/61752665\/jeaf045.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/26\/5\/918\/61752665\/jeaf045.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T02:56:01Z","timestamp":1746068161000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/26\/5\/918\/7998778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,4]]},"references-count":30,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,2,4]]},"published-print":{"date-parts":[[2025,4,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeaf045","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,5]]},"published":{"date-parts":[[2025,2,4]]}}}