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 R., Giannini, Cristina, La Carruba, Salvatore, Angelillis, Marco, Spontoni, Paolo, De Carlo, Marco, Petronio, Anna Sonia, and Di Bello, Vitantonio
- Subjects
AORTIC stenosis ,CHI-squared test ,CONFIDENCE intervals ,CORONARY disease ,PROSTHETIC heart valves ,LONGITUDINAL method ,VENTRICULAR remodeling ,PROPORTIONAL hazards models ,KAPLAN-Meier estimator ,LEFT ventricular hypertrophy - 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 ( EDVI
20 ). 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. [ABSTRACT FROM AUTHOR]- Published
- 2017
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