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Prosthesis-patient mismatch defined by cardiac computed tomography versus echocardiography after transcatheter aortic valve replacement.
- Source :
- Journal of Cardiovascular Computed Tomography; Sep2021, Vol. 15 Issue 5, p403-411, 9p
- Publication Year :
- 2021
-
Abstract
- Evaluation of prosthesis-patient mismatch (P-PM) after transcatheter aortic valve replacement (TAVR) by transthoracic echocardiography (TTE) has provided conflicting results regarding its impact on outcomes. Whether post-TAVR computed tomography angiography (CTA) evaluation of P-PM can improve our understanding is unknown. We aimed to evaluate the inter-modality (TTE vs. CTA) agreement, inter-valve platform (balloon-expanding valve [BEV] vs. self-expandable valve [SEV]) differences in P-PM severity, and outcomes related to P-PM after TAVR. We analyzed patients with both CTA and TTE before and after TAVR. Indexed effective orifice area was calculated using two methods: TTE-derived left ventricular outflow tract (LVOT) area from measured diameter and post-TAVR CTA-measured area. Body size specific cut-offs for P-PM severity were used: for body mass index (BMI) < 30 kg/m<superscript>2</superscript>, moderate = 0.66–0.85 cm<superscript>2</superscript>/m<superscript>2</superscript> and severe≤0.65 cm<superscript>2</superscript>/m<superscript>2</superscript>; for BMI ≥30 kg/m<superscript>2</superscript>, moderate = 0.56–0.70 cm<superscript>2</superscript>/m<superscript>2</superscript> and severe≤0.55 cm<superscript>2</superscript>/m<superscript>2</superscript>. A total of 447 patients were included (median age, 83 years; 54% male). The prevalence of P-PM (moderate or severe) was lower with CTA vs. TTE (3.5% vs. 19.5%, p < 0.001). The prevalence of P-PM measured by TTE was more common in BEV compared to SEV (p = 0.002), while CTA assessment showed no difference in P-PM incidence and severity between TAVR platforms (p = 0.40). In multivariable analysis, CTA-defined but not TTE-defined P-PM was associated with mortality after TAVR (HR:3.97; 95%CI,1.55–10.2; p = 0.004). Both CTA-defined and TTE-defined P-PM were associated with the composite of death and heart failure rehospitalization. Although post-TAVR CTA substantially downgraded the prevalence of P-PM compared to TTE, it identified a subset of patients with clinically relevant P-PM which associated with outcomes. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 19345925
- Volume :
- 15
- Issue :
- 5
- Database :
- Supplemental Index
- Journal :
- Journal of Cardiovascular Computed Tomography
- Publication Type :
- Academic Journal
- Accession number :
- 152042214
- Full Text :
- https://doi.org/10.1016/j.jcct.2021.01.001