1-Year Survival After TAVR of Patients With Low-Flow, Low-Gradient and High-Gradient Aortic Valve Stenosis in Matched Study Populations

Fischer‐Rasokat, Ulrich; Renker, Matthias; Liebetrau, Christoph; Linden, Arnaud Van; Arsalan, Mani; Weferling, Maren; Rolf, Andreas; Doss, Mirko; Möllmann, Helge; Walther, Thomas; Hamm, Christian W.; Kim, Won-Keun

doi:10.1016/j.jcin.2019.01.233

Cited by 44 publications

(44 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Third, we excluded patients who did not survive the peri‐operative period. Therefore, our study does not address the risk of early mortality in these patients, which has been previously reported to be increased . Finally, the cohort is predominantly Caucasian and our findings may not be generalizable to other ethnic groups.…”

Section: Discussionmentioning

confidence: 82%

“…Previous studies in patients with LF AS have focused on the peri‐operative risk associated with TAVR . In the German Aortic Valve Registry patients with LF AS had higher in‐hospital mortality when compared with patients with NF AS (7.8% versus 4.9%, p = .020 .…”

Section: Discussionmentioning

confidence: 99%

“…In the German Aortic Valve Registry patients with LF AS had higher in‐hospital mortality when compared with patients with NF AS (7.8% versus 4.9%, p = .020 . Given the observational nature of registry data and the potential for confounding, Fischer‐Rasokat et al conducted a propensity‐matched analysis of 136 patients treated at a single institution and found that LF AS was associated with worse survival when compared with NF AS (HR = 2.12, 95% CI = 1.02–4.39, p = .04) . However, given the poor prognosis of LF LG, severe AS under medical therapy, and improved survival with TAVR, the finding of increased perioperative risk with TAVR has limited practical clinical relevance.…”

Section: Discussionmentioning

confidence: 99%

“…10 Previous studies in patients with LF AS have focused on the perioperative risk associated with TAVR. [15][16][17][18] In the German Aortic Valve…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Changes in quality of life in patients with low‐flow aortic stenosis undergoing transcatheter aortic valve replacement

Ahmed

Alsidawi

Bae

et al. 2020

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…10 Previous studies in patients with LF AS have focused on the perioperative risk associated with TAVR. [15][16][17][18] In the German Aortic Valve…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Changes in quality of life in patients with low‐flow aortic stenosis undergoing transcatheter aortic valve replacement

Ahmed

Alsidawi

Bae

et al. 2020

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…Currently, it is highly recommended to perform TAVI before deterioration of cardiac function, given the evidence that post-TAVI outcome is worse in patients with low-flow, low-gradient AS [16]. Although the patients with such a too-progressed AS are not good candidates for TAVI and are rarely referred to TAVI in the current literature, their P-AVP might be regulated differently from our cohort.…”

Section: Regulation Of P-avp: Non-osmotic Pathway Vs Osmotic Pathwaymentioning

confidence: 80%

Regulation and Clinical Implication of Arginine Vasopressin in Patients with Severe Aortic Stenosis Referred to Trans-Catheter Aortic Valve Implantation

et al. 2020

View full text Add to dashboard Cite

Background and objectives: Plasma arginine vasopressin (P-AVP) is regulated by the non-osmotic pathway in patients with heart failure (HF) and reduced ejection fraction. However, the regulation of P-AVP in patients with severe aortic stenosis (AS) remains unknown. Materials and Methods: Consecutive patients with severe AS who received trans-catheter aortic valve implantation (TAVI) between Apr 2016 and Apr 2019 were enrolled in this prospective study. Clinical data including P-AVP were obtained just before TAVI, and the correlation between P-AVP and other variables was investigated. Results: In total, 159 patients with severe AS (85.3 ± 4.6 years, male 26%) were enrolled. P-AVP was 1.45 ± 1.13 ng/mL and cardiac index was relatively preserved (2.76 ± 0.54 L/min/m2). There was no significant correlation between cardiac index and P-AVP (p > 0.05), whereas plasma osmolality had a moderate positive correlation with P-AVP (r = 0.35, p < 0.01), predominantly due to blood urea nitrogen (r = 0.27, p < 0.01). Patients with diuretics had significantly higher P-AVP than those without diuretics (1.65 ± 1.43 vs. 1.22 ± 0.57 pg/mL, p < 0.01). Two-year survivals free from HF readmission were statistically comparable irrespective of the level of pre-procedural P-AVP (p = 0.44). Conclusion: In patients with severe high-gradient AS who received TAVI, the P-AVP level was dominantly regulated by plasma osmolality instead of arterial underfilling. The clinical implication of elevated P-AVP in the TAVI candidates is the next concern.

show abstract

Prognostic impact of echocardiographic mean transvalvular gradients in patients with aortic stenosis and low flow undergoing transcatheter aortic valve implantation

Fischer‐Rasokat

Renker

Liebetrau

et al. 2021

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

Background: Blunted left ventricular hemodynamics reflected by a low stroke volume index (SVI) ≤35 mL/m 2 body surface area (low flow [LF]) in patients with severe aortic stenosis (AS) are associated with worse outcomes even after correction of afterload by transcatheter aortic valve implantation (TAVI). These patients can have a low or high transvalvular mean pressure gradient (MPG). We investigated the impact of the pre-interventional MPG on outcomes after TAVI. Methods: Patients with LF AS were classified into those with normal (EF ≥ 50%; LF/NEF) or reduced ejection fraction (EF < 50%; LF/REF) and were then stratified according to an MPG < or ≥ 40 mmHg. Patients with SVI >35 mL/m 2 (normal flow; NF) served as controls.Results: 597 patients with LF/NEF, 264 patients with LF/REF and 975 patients with NF were identified. Among all groups those patients with a low MPG were characterized by higher cardiovascular risk. In patients with LF/REF, functional improvement post-TAVI was less pronounced in low-MPG patients. One-year survival was significantly worse in LF AS patients with a low vs. high MPG (LF/NEF 16.5% vs. 10.5%, p = 0.022; LF/REF 25.4% vs. 8.0%, p = 0.002), whereas no differences were found in NF patients (8.7% vs. 10.0%, p = 0.550). In both LF AS groups, a low preprocedural MPG emerged as an independent predictor of mortality. Conclusions:In patients with LF AS, an MPG cut-off of 40 mmHg defines two patient populations with fundamental differences in outcomes after TAVI. Patients with LF AS and a high MPG have the same favorable prognosis as patients with NF AS.

show abstract

1-Year Survival After TAVR of Patients With Low-Flow, Low-Gradient and High-Gradient Aortic Valve Stenosis in Matched Study Populations

Cited by 44 publications

References 22 publications

Changes in quality of life in patients with low‐flow aortic stenosis undergoing transcatheter aortic valve replacement

Changes in quality of life in patients with low‐flow aortic stenosis undergoing transcatheter aortic valve replacement

Regulation and Clinical Implication of Arginine Vasopressin in Patients with Severe Aortic Stenosis Referred to Trans-Catheter Aortic Valve Implantation

Prognostic impact of echocardiographic mean transvalvular gradients in patients with aortic stenosis and low flow undergoing transcatheter aortic valve implantation

Contact Info

Product

Resources

About