1. Left ventricular stiffness predicts outcome in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation
- Author
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Conte, Lorenzo, Fabiani, Iacopo, Pugliese, NICOLA RICCARDO, Giannini, Cristina, La Carruba, Salvatore, Angelillis, Marco, Spontoni, Paolo, De Carlo, Marco, Petronio, Anna, Anna, Sonia, and DI BELLO, Vitantonio
- Subjects
aortic stenosis, aortic valve replacement, diastolic function, left ventricular end-diastolic pressure, left ventricular stiffness ,Male ,medicine.medical_specialty ,Transcatheter aortic ,Heart Ventricles ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Ventricular Function, Left ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,left ventricular stiffness ,Internal medicine ,medicine ,Humans ,aortic valve replacement ,Radiology, Nuclear Medicine and imaging ,In patient ,030212 general & internal medicine ,Prospective Studies ,Adverse effect ,Body surface area ,Aged, 80 and over ,business.industry ,diastolic function ,aortic stenosis ,Stroke Volume ,Aortic Valve Stenosis ,medicine.disease ,Confidence interval ,Surgery ,Stenosis ,Treatment Outcome ,Echocardiography ,Heart Valve Prosthesis ,Cardiology ,Ventricular pressure ,Female ,Cardiology and Cardiovascular Medicine ,business ,left ventricular end-diastolic pressure ,Follow-Up Studies - Abstract
Objectives Assessment of the prognostic role of left ventricular stiffness (LVS) in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Methods We performed a complete two-dimensional transthoracic echocardiographic study before and after TAVI in patients with severe AS at high surgical risk. In order to assess LVS, we measured LV end-diastolic pressure (EDP) invasively during TAVI and LV end-diastolic volume (EDV) by means of echocardiography. We defined LVS as the EDV indexed by body surface area at an EDP of 20 mm Hg (EDVI20). Our aim was to assess the impact of LVS on one-year all-cause mortality after TAVI. Results One hundred sixty-six patients undergoing TAVI (64% female; mean age 82.7 ± 5.1 years) were enrolled. Seven patients died within the first 30 days after TAVI and 21 within 1 year. Overall follow-up duration was 580 ± 478 days. At multivariate analysis, independent predictors of 1-year all-cause mortality were moderate-to-severe paravalvular leak (PVL; HR 4.7, 95% confidence interval [CI] 1.9-11, P=.0003), female gender (HR 3.5, 95% CI 1.0-12, P=.045), and EDVI20 (HR 0.94, 95% CI 0.90-0.98, P=.015). In particular, patients with higher LVS (EDVI20≤48 mL/m2) had a 1-year mortality of 26.9% vs 7.4% in patients with lower LVS (EDVI20>48 mL/m2; HR 4.2, 95% CI 1.6-10.6, P=.0007). Patients with higher LVS who developed moderate-to-severe PVL had the worst outcome (incremental chi-square test, P=.014). Conclusion In patients with AS, an increased LVS has a negative prognostic impact. Development of significant PVL in patients with higher LVS had an incremental adverse effect.
- Published
- 2016