Impact of left ventricular filling parameters on outcome of patients undergoing trans-catheter aortic valve replacement

Kramer, Judith M.; Biner, Simon; Ghermezi, Matthew; Pressman, Gregg S.; Shmueli, Hezzi; Shimiaie, Jason; Finkelstein, Arie; Banai, Shmuel; Steinvil, Arie; Buffle, Eric; Aviram, Galit; Ingbir, Meirav; Nesher, Nahum; Keren, Gad

doi:10.1093/ehjci/jew097

Cited by 3 publications

(1 citation statement)

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“…TAVI improved left ventricular function, and the improvement in left ventricular ejection fraction was the predictor of a good prognosis in patients with severe AS who presented with reduced left ventricular ejection fraction 11–14. However, Le Ven et al 15 reported that left ventricular ejection fraction underestimates myocardial systolic dysfunction in cases with concentric remodelling.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of postprocedure stroke volume in patients with low-gradient aortic stenosis

et al. 2019

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ObjectiveThe effect of postoperative blood flow status on the prognosis of patients with low-gradient severe aortic stenosis (AS) has not been examined. Severe AS is associated with a higher mortality rate after transcatheter aortic valve implantation (TAVI). We examined the prognostic value of low-flow status by comparing stroke volume indices (SVi) before and after TAVI in patients with symptomatic, low-gradient severe AS.MethodsA total of 1613 patients with severe symptomatic AS who underwent TAVI in 14 Japanese institutes for low-gradient severe AS (418 patients, median age 84 years, 32.5% men) were prospectively enrolled. The primary endpoint was cardiovascular mortality during follow-up after TAVI, and independent predictors were evaluated. Receiver operating characteristic curves were generated to determine the optimal cut-off value of post-TAVI SVi for predicting cardiovascular mortality, and the receiver operating characteristic curves of pre-TAVI and post-TAVI SVi were compared.ResultsThe cardiovascular mortality rate was 4.1% (17 patients) during follow-up (median 9.2 months). Multivariate analysis revealed post-TAVI SVi to be an independent predictor of cardiovascular mortality (per 10 mL/m2 decrease; HR, 2.0; 95% CI 1.28 to 3.12). The optimal cut-off value of post-TAVI SVi was 41.4 mL/m2. Post-TAVI SVi showed significantly larger area under the curve than pre-TAVI SVi (0.74 (95% CI 0.69 to 0.79) vs 0.61 (95% CI 0.56 to 0.65), p<0.05).ConclusionsPost-TAVI SVi is a better predictor of cardiovascular mortality than pre-TAVI SVi in patients with symptomatic low-gradient severe AS. Low-flow and low-normal-flow status (35≤ SVi <40 mL/m2) require careful management after TAVI.

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Section: Discussionmentioning

confidence: 99%