TY - JOUR
T1 - First description and validation of a new method for estimating aortic stenosis burden and predicting the functional response to TAVI
AU - de la Torre Hernandez, Jose M.
AU - Veiga Fernandez, Gabriela
AU - Ben-Assa, Eyal
AU - Iribarren, Julia
AU - Sainz Laso, Fermin
AU - Lee, Dae Hyun
AU - Ruisanchez Villar, Cristina
AU - Lerena, Piedad
AU - Garcia Camarero, Tamara
AU - Iribarren Sarrias, Jose L.
AU - Cuesta Cosgaya, Jose M.
AU - Maza Fernandez, Maria E.
AU - Garilleti, Celia
AU - Fradejas-Sastre, Victor
AU - Benito, Mercedes
AU - Barrera, Sergio
AU - Gil Ongay, Aritz
AU - Vazquez de Prada, Jose A.
AU - Zueco, Javier
N1 - Publisher Copyright:
2023 de la Torre Hernandez, Veiga Fernandez, Ben-Assa, Iribarren, Sainz Laso, Lee, Ruisanchez Villar, Lerena, Garcia Camarero, Iribarren Sarrias, Cuesta Cosgaya, Maza Fernandez, Garilleti, Fradejas-Sastre, Benito, Barrera, Gil Ongay, Vazquez de Prada and Zueco.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background: Up to one-fifth of patients continue to have poor quality of life after transcatheter aortic valve implantation (TAVI), with an additional similar proportion not surviving 1 year after the procedure. We aimed to assess the value of a new method based on an integrated analysis of left ventricular outflow tract flow velocity and aortic pressure to predict objective functional improvement and prognosis after TAVI. Methods: In a cohort of consecutive patients undergoing TAVI, flow velocity–pressure integrated analysis was obtained from simultaneous pressure recordings in the ascending aorta and flow velocity recordings in the left ventricular outflow tract by echocardiography. Objective functional improvement 6 months after TAVI was assessed through changes in a 6-min walk test and NT-proBNP levels. A clinical follow-up was conducted at 2 years. Results: Of the 102 patients studied, 82 (80.4%) showed objective functional improvement. The 2-year mortality of these patients was significantly lower (9% vs. 44%, p = 0.001). In multivariate analysis, parameter “(Pressure at Vmax − Pressure at Vo)/Vmax” was found to be an independent predictor for objective improvement. The C-statistic was 0.70 in the overall population and 0.78 in the low-gradient subgroup. All echocardiographic parameters and the valvuloarterial impedance showed a C-statistic of <0.6 for the overall and low-gradient patients. In a validation cohort of 119 patients, the C-statistic was 0.67 for the total cohort and 0.76 for the low-gradient subgroup. Conclusion: This new method allows predicting objective functional improvement after TAVI more precisely than the conventional parameters used to assess the severity of aortic stenosis, particularly in low-gradient patients.
AB - Background: Up to one-fifth of patients continue to have poor quality of life after transcatheter aortic valve implantation (TAVI), with an additional similar proportion not surviving 1 year after the procedure. We aimed to assess the value of a new method based on an integrated analysis of left ventricular outflow tract flow velocity and aortic pressure to predict objective functional improvement and prognosis after TAVI. Methods: In a cohort of consecutive patients undergoing TAVI, flow velocity–pressure integrated analysis was obtained from simultaneous pressure recordings in the ascending aorta and flow velocity recordings in the left ventricular outflow tract by echocardiography. Objective functional improvement 6 months after TAVI was assessed through changes in a 6-min walk test and NT-proBNP levels. A clinical follow-up was conducted at 2 years. Results: Of the 102 patients studied, 82 (80.4%) showed objective functional improvement. The 2-year mortality of these patients was significantly lower (9% vs. 44%, p = 0.001). In multivariate analysis, parameter “(Pressure at Vmax − Pressure at Vo)/Vmax” was found to be an independent predictor for objective improvement. The C-statistic was 0.70 in the overall population and 0.78 in the low-gradient subgroup. All echocardiographic parameters and the valvuloarterial impedance showed a C-statistic of <0.6 for the overall and low-gradient patients. In a validation cohort of 119 patients, the C-statistic was 0.67 for the total cohort and 0.76 for the low-gradient subgroup. Conclusion: This new method allows predicting objective functional improvement after TAVI more precisely than the conventional parameters used to assess the severity of aortic stenosis, particularly in low-gradient patients.
KW - aortic pressure
KW - aortic stenosis
KW - clinical outcomes
KW - flow velocity
KW - left ventricular outflow tract
KW - transcatheter aortic valve implantation
UR - http://www.scopus.com/inward/record.url?scp=85177863992&partnerID=8YFLogxK
U2 - 10.3389/fcvm.2023.1215826
DO - 10.3389/fcvm.2023.1215826
M3 - Article
C2 - 38034386
AN - SCOPUS:85177863992
SN - 2297-055X
VL - 10
JO - Frontiers in Cardiovascular Medicine
JF - Frontiers in Cardiovascular Medicine
M1 - 1215826
ER -