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CT-Defined Prosthesis-Patient Mismatch Downgrades Frequency and Severity, and Demonstrates No Association With Adverse Outcomes After Transcatheter Aortic Valve Replacement.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2017 Aug 14; Vol. 10 (15), pp. 1578-1587. Date of Electronic Publication: 2017 Jul 19. - Publication Year :
- 2017
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Abstract
- Objectives: This study sought to determine if indexed effective orifice area (EOAi), using left ventricular outflow tract measured from computed tomography (EOAi <subscript>CT</subscript> ), reclassified prosthesis-patient mismatch (PPM) compared with conventional echocardiogram-defined measurements (EOAi <subscript>TTE</subscript> ).<br />Background: PPM does not predict mortality following transcatheter aortic valve replacement (TAVR). However, it is unknown if the EOAi <subscript>CT</subscript> of the left ventricular outflow tract improves risk stratification.<br />Methods: A total of 765 TAVR patients from the PARTNER II (Placement of Aortic Transcatheter Valves II) trial S3i cohort were evaluated. EOAi was calculated using the continuity equation, and the left ventricular outflow tract area was derived from baseline computed tomography. Traditional echocardiographic categories defined PPM: absent (>0.85 cm <superscript>2</superscript> /m <superscript>2</superscript> ), moderate (≥0.65 and ≤0.85 cm <superscript>2</superscript> /m <superscript>2</superscript> ), or severe (≤0.65 cm <superscript>2</superscript> /m <superscript>2</superscript> ). Correlation of EOAi <subscript>CT</subscript> and EOAi <subscript>TTE</subscript> to 1-year outcomes was performed.<br />Results: The incidence of PPM was 24% with EOA <subscript>CT</subscript> compared with 45% with EOAi <subscript>TTE</subscript> . Only 6% of PPM was graded severe by EOAi <subscript>CT</subscript> compared with 9% by EOAi <subscript>TTE</subscript> . EOAi <subscript>TTE</subscript> , but not EOAi <subscript>CT</subscript> , defined PPM showed association with reduced left ventricular mass regression (p = 0.03 vs. p = 0.52). There was no association between PPM and death or rehospitalization at 1 year with either modality. EOA <subscript>CT</subscript> was associated with minor stroke at 1 year (log-rank p = 0.04), and EOAi <subscript>TTE</subscript> with stroke/transient ischemic attack (log-rank p = 0.030). Furthermore, when subjects with mild or greater paravalvular regurgitation were excluded, the presence of PPM did not show association with any outcome.<br />Conclusions: EOAi <subscript>CT</subscript> downgrades frequency and severity of PPM in patients after TAVR, and was not associated with mortality 1 year after TAVR. EOAi <subscript>TTE</subscript> , but not EOAi <subscript>CT</subscript> , was associated with less left ventricular mass regression.<br /> (Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Aortic Valve diagnostic imaging
Aortic Valve physiopathology
Aortic Valve Stenosis diagnostic imaging
Aortic Valve Stenosis mortality
Aortic Valve Stenosis physiopathology
Area Under Curve
Echocardiography, Doppler
Female
Humans
Hypertrophy, Left Ventricular diagnostic imaging
Hypertrophy, Left Ventricular physiopathology
Kaplan-Meier Estimate
Male
Postoperative Complications mortality
Postoperative Complications physiopathology
Postoperative Complications prevention & control
Predictive Value of Tests
Prosthesis Design
ROC Curve
Registries
Reproducibility of Results
Risk Assessment
Risk Factors
Severity of Illness Index
Transcatheter Aortic Valve Replacement adverse effects
Transcatheter Aortic Valve Replacement mortality
Treatment Outcome
Aortic Valve surgery
Aortic Valve Stenosis surgery
Heart Valve Prosthesis
Postoperative Complications diagnostic imaging
Tomography, X-Ray Computed
Transcatheter Aortic Valve Replacement instrumentation
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 10
- Issue :
- 15
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 28734891
- Full Text :
- https://doi.org/10.1016/j.jcin.2017.05.031