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Clinical and Echocardiographic Characteristics of Flow-Based Classification Following Balloon-Expandable Transcatheter Heart Valve in PARTNER Trials.
- Source :
-
JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2023 Jan; Vol. 16 (1), pp. 1-9. Date of Electronic Publication: 2022 Aug 17. - Publication Year :
- 2023
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Abstract
- Background: Current expected normal echocardiographic measures of transcatheter heart valve (THV) function were derived from pooled cohorts of the randomized trials; however, THV function by flow state before or following transcatheter aortic valve replacement (TAVR) has not been previously reported.<br />Objectives: This study sought to assess the expected normal echocardiographic hemodynamics for the balloon-expandable THV grouped by stroke volume index (SVI).<br />Methods: Patients with severe aortic stenosis enrolled in PARTNER (Placement of Aortic Transcatheter Valves) 1 (high/extreme surgical risk), PARTNER 2 (intermediate surgical risk), or PARTNER 3 (low surgical risk) trials with complete core laboratory echocardiography were included. Patients were grouped by low-flow (SVI <subscript>LOW</subscript>  <35 mL/m <superscript>2</superscript> ) and normal-flow (SVI <subscript>NORMAL</subscript>  ≥35 mL/m <superscript>2</superscript> ). Mean gradient, effective orifice area (EOA), and Doppler velocity index (DVI) were collected at baseline and at 30 days post-TAVR. Prosthesis-patient mismatch (PPM) was both calculated and predicted from normative data, using defined criteria.<br />Results: In the entire population (N = 4,991), mean age was 81.8 years, 58% of patients were male, and 42% had low flow. Compared with patients with baseline SVI <subscript>NORMAL</subscript> , those with SVI <subscript>LOW</subscript> were more likely to be male; have more comorbidities; and lower left ventricular ejection fraction, mean gradient, and EOA. Post-TAVR, SVI <subscript>LOW</subscript> increased to SVI <subscript>NORMAL</subscript> in 17.3% and SVI <subscript>NORMAL</subscript> decreased to SVI <subscript>LOW</subscript> in 12.3% of patients. Using baseline SVI, follow-up EOA, mean gradient, and DVI for patients with SVI <subscript>LOW</subscript> tended to be lower than for patients with SVI <subscript>NORMAL</subscript> . Using the post-TAVR SVI, follow-up EOA, mean gradient, and DVI were significantly lower for patients with SVI <subscript>LOW</subscript> than for those with SVI <subscript>NORMAL</subscript> (P < 0.001 for all). The incidence of calculated, but not predicted, severe PPM was higher in patients with low flow than it was in patients with normal flow, suggesting pseudo-PPM in the presence of low flow.<br />Conclusions: This study demonstrates that flow affects THV hemodynamics and both baseline and follow-up SVI should be considered when predicting THV hemodynamics prior to TAVR, as well as assessing valve function following valve implantation.<br />Competing Interests: Funding Support and Author Disclosures Dr Pibarot has received funding from Edwards Lifesciences, Medtronic, Pi-Cardia, and Cardiac Phoenix for echocardiography core laboratory analyses and research studies in the field of transcatheter valve therapies, for which he received no personal compensation; and has received lecture fees from Edwards Lifesciences and Medtronic. Dr Leipsic has served as a consultant to Circle CVI and HeartFlow; and has institutional core laboratory contracts with Edwards Lifesciences, Medtronic, Boston Scientific, Abbott, PI-Cardia, and Conformal. Dr Hahn has received speaker fees from Abbott Vascular, Baylis Medical, and Edwards Lifesciences; has performed institutional consulting for Abbott Structural, Edwards Lifesciences, and Medtronic; has equity in Navigate; and has served as Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.<br /> (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Male
Aged, 80 and over
Female
Stroke Volume
Treatment Outcome
Ventricular Function, Left
Predictive Value of Tests
Aortic Valve diagnostic imaging
Aortic Valve surgery
Echocardiography
Hemodynamics
Prosthesis Design
Aortic Valve Stenosis diagnostic imaging
Aortic Valve Stenosis surgery
Heart Valve Prosthesis
Transcatheter Aortic Valve Replacement adverse effects
Heart Valve Prosthesis Implantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7591
- Volume :
- 16
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 36599555
- Full Text :
- https://doi.org/10.1016/j.jcmg.2022.05.010