Flow, Reflected by Stroke Volume Index, Is a Risk Marker in High-Gradient Aortic Stenosis Patients Undergoing Transcatheter Aortic Valve Replacement.
Can J Cardiol
; 36(1): 112-118, 2020 01.
Article
en En
| MEDLINE
| ID: mdl-31785992
ABSTRACT
BACKGROUND:
Tools are needed to identify patients at increased risk after transcatheter aortic valve replacement (TAVR). Indexed stroke volume (SVi) is an echocardiographic measurement that is used for low-gradient aortic stenosis. We studied whether low SVi is a high-risk marker in patients with high-gradient aortic stenosis (HG-AS) and assessed the relationship between SVi and left ventricle (LV) systolic function in contributing to this risk.METHODS:
A total of 816 consecutive patients who underwent TAVR were screened, and only patients with HG-AS were included. Low flow (LF) was defined as SVi ≤ 35 mL/m2. The primary endpoint was defined as a combination of all-cause mortality and readmission with heart failure at 1 year.RESULTS:
Of the 476 patients with HG-AS, 215 (45%) had LF. They had higher N-terminal pro b-type natriuretic peptide (NTproBNP) (2565 [1037-5492] vs 1730 [818-3575], P = 0.006) and smaller indexed valve area (0.30 ± 0.10 vs 0.37 ± 0.10 cm2/m2, P < 0.001) when compared with normal flow patients. The primary endpoint was higher in LF patients (hazard ratio, 1.49; 95% confidence interval, 1.01-2.21; P = 0.045). There were no statistical differences in the individual components of death (13.0% vs 8.9%, P = 0.16) or heart failure (14.9% vs 10.1%, P = 0.12). When stratified according to LV function, low SVi was associated with future adverse events in patients with reduced function (hazard ratio, 3.37; 95% confidence interval, 1.26-8.98; P = 0.015) with comparable clinical outcomes in those with preserved function. LF was an independent predictor of adverse events in the reduced LV function subgroup.CONCLUSIONS:
SVi can further characterize patients with HG-AS and may help to identify those who are at increased risk after TAVR.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Estenosis de la Válvula Aórtica
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Volumen Sistólico
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Función Ventricular Izquierda
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Reemplazo de la Válvula Aórtica Transcatéter
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged80
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Female
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Humans
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Male
Idioma:
En
Año:
2020
Tipo del documento:
Article