Prognostic impact of postprocedure stroke volume in patients with low-gradient aortic stenosis. Issue 1 (24th May 2019)

• Record Type: Journal Article
• Authors: Nara, Yugo; Kataoka, Akihisa; Watanabe, Yusuke; Makoto, Nakashima; Hioki, Hirofumi; Kawashima, Hideyuki; Fukuko, Nagura; Kozuma, Ken; Shirai, Shinichi; Tada, Norio; Araki, Motoharu; Naganuma, Toru; Yamanaka, Futoshi; Ueno, Hiroshi; Tabata, Minoru; Mizutani, Kazuki; Higashimori, Akihiro; Takagi, Kensuke; Yamamoto, Masanori; Hayashida, Kentaro
• Is Part Of: Open heart. Volume 6:Issue 1(2019)
• Publication Date: 2019-05-24
• Subjects: aortic stenosis -- echocardiography -- transcatheter valve interventions; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Patients -- Periodicals; 616.12005
• DOI: 10.1136/openhrt-2018-000988
• Languages: English
• ISSNs: 2398-595X

Abstract

Abstract : Objective: The 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. Methods: A 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. Results: The 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/m 2 decrease; HR, 2.0; 95% CI 1.28 to 3.12). The optimal cut-off value of post-TAVI SVi was 41.4 mL/m 2 . 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). Conclusions: Post-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/m 2 ) require careful management after TAVI.