scholarly journals Prognostic Value of Ventricular‐Arterial Coupling After Transcatheter Aortic Valve Replacement on Midterm Clinical Outcomes

2021 ◽  
Author(s):  
Hiroaki Yokoyama ◽  
Futoshi Yamanaka ◽  
Koki Shishido ◽  
Tomoki Ochiai ◽  
Shohei Yokota ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Cardiovascular Death ◽  
Transcatheter Aortic Valve ◽  
Group 4 ◽  
Group 2

Background Ventricular‐arterial coupling predicts outcomes in patients with heart failure. The arterial elastance to end‐systolic elastance ratio (Ea/Ees) is a noninvasively assessed index that reflects ventricular‐arterial coupling. We aimed to determine the prognostic value of ventricular‐arterial coupling assessed through Ea/Ees after transcatheter aortic valve replacement to predict clinical events. Methods and Results We retrieved data on 1378 patients (70% women) who underwent transcatheter aortic valve replacement between October 2013 and May 2017 from the OCEAN‐TAVI (Optimized transCathEter vAlvular iNtervention) Japanese multicenter registry. We determined the association between Ea/Ees and the composite end point of hospitalization for heart failure and cardiovascular death by classifying the patients into quartiles based on Ea/Ees values (group 1: <0.326; group 2: 0.326–0.453; group 3: 0.453–0.666; and group 4: >0.666) during the midterm follow‐up after transcatheter aortic valve replacement. During a median follow‐up period of 736 days (interquartile range, 414–956), there were 247 (17.9%) all‐cause deaths, 89 (6.5%) cardiovascular deaths, 130 (9.4%) hospitalizations for heart failure, and 199 (14.4%) composite events of hospitalization for heart failure and cardiovascular death. The incidence of the composite end point was significantly higher in group 2 (hazard ratio [HR], 1.76; 95% CI, 1.08–2.87 [ P =0.024]), group 3 (HR, 2.43; 95% CI, 1.53–3.86 [ P <0.001]), and group 4 (HR, 2.89; 95% CI, 1.83–4.57 [ P <0.001]) than that in group 1. On adjusted multivariable Cox analysis, Ea/Ees was significantly associated with composite events (HR, 1.47 per 1‐unit increase; 95% CI, 1.08–2.01 [ P =0.015]). Conclusions These findings suggest that a higher Ea/Ees at discharge after transcatheter aortic valve replacement is associated with adverse clinical outcomes during midterm follow‐up. Registration URL: https://www.upload.umin.ac.jp/ . Unique identifier: UMIN000020423.

scholarly journals Predictive Role of Selvester QRS Score in Patients Undergoing Transcatheter Aortic Valve Replacement

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Bignoto ◽  
D Le Bihan ◽  
R.B.M Barretto ◽  
A.I.O Ramos ◽  
D.A.R Moreira ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Mortality Risk ◽  
Transcatheter Aortic Valve Replacement ◽  
Cardiovascular Death ◽  
Inferior Wall ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality

Abstract Introduction Few data exist regarding the late clinical impact of the Selvester score prediction of myocardial fibrosis after transcatheter aortic valve replacement (TAVR). This study evaluated the predictive power of the Selvester score on survival in patients with aortic stenosis (AS) undergoing TAVR. Methods and results Patients with severe AS who had preoperative electrocardiograms were included. Clinical follow-up was obtained retrospectively. The primary endpoint was all-cause mortality. Secondary endpoints were cardiovascular death and major adverse cardiac events (MACE). Two hundred twenty-eight patients were included (mean age, 81.5±7.4 years; women, 58.3%). Deceased patients had a higher mean score (4.6±3.2 vs. 1.4±1.3; p&lt;0.001). At a mean follow-up of 36.2±21.2 months, the Selvester score was independently associated with all-cause mortality (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.48–1.84; p&lt;0.001), cardiovascular death (HR, 1.59; 95% CI, 1.38–1.74; p&lt;0.001), and MACE (HR, 1.55; 95% CI, 1.30–1.68; p&lt;0.001). After 5 years, the mortality risk was incrementally related to the Selvester score. The involvement of the inferior wall of the left ventricle was a lower mortality risk (HR, 0.42; 95% CI, 0.18 to 0.98; p=0.046). For a Selvester score of 3, the area under the curve showed 0.92, 0.94, and 0.86 (p&lt;0.001), respectively, for 1, 2, and 3 years. Conclusions Elevated Selvester scores increase the risk of poor outcomes in patients with AS undergoing TAVR. The involvement of the anterior or lateral wall presents worse prognosis. Kaplain Meier and ROC Curve Funding Acknowledgement Type of funding source: None

scholarly journals Electrocardiographic Strain Pattern Is a Major Determinant of Rehospitalization for Heart Failure After Transcatheter Aortic Valve Replacement

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Joé Heger ◽  
Antonin Trimaille ◽  
Marion Kibler ◽  
Benjamin Marchandot ◽  
Marilou Peillex ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Bundle Branch Block ◽  
Strain Pattern ◽  
Transcatheter Aortic Valve

Background Electrocardiographic strain pattern (ESP) has recently been associated with increased adverse outcome in aortic stenosis and after surgical aortic valve replacement. Our study sought to determine the impact and incremental value of ESP pattern in predicting adverse outcome after transcatheter aortic valve replacement. Methods and Results A total of 585 patients with severe aortic stenosis (mean age, 83±7 years; men, 39.8%) were enrolled for transcatheter aortic valve replacement from November 2012 to May 2018. ESP was defined as ≥1‐mm concave down‐sloping ST‐segment depression and asymmetrical T‐wave inversion in the lateral leads. The primary end points of the study were all‐cause mortality, rehospitalization for heart failure, myocardial infarction, and stroke. A total of 178 (30.4%) patients were excluded because of left bundle‐branch block (n=103) or right bundle‐branch block (n=75). Among the 407 remaining patients, 106 had ESP (26.04%). At a median follow‐up of 20.00 months (11.70–29.42 months), no impact of electric strain on overall and cardiac death could be established. By contrast, incidence of rehospitalization for heart failure was significantly higher (33/106 [31.1%] versus 33/301 [11%]; P <0.001) in patients with ESP. By multivariate analyses, ESP remained a strong predictor of rehospitalization for heart failure (hazard ratio, 2.75 [95% CI, 1.61–4.67]; P <0.001). Conclusions In patients with aortic stenosis who were eligible for transcatheter aortic valve replacement, ESP is frequent and associated with an increased risk of postinterventional heart failure regardless of preoperative left ventricular hypertrophy. ESP represents an easy, objective, reliable, and low‐cost tool to identify patients who may benefit from intensified postinterventional follow‐up.

scholarly journals Renin–angiotensin system blockade after transcatheter aortic valve replacement (TAVR) improves intermediate survival

2019 ◽  
Vol 11 (3) ◽  
pp. 176-181 ◽  
Author(s):  
Brent Klinkhammer
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Renin Angiotensin System ◽  
Rural Patient ◽  
Angiotensin System ◽  
Transcatheter Aortic Valve

Introduction: Hypertension is common in patients with severe aortic stenosis undertaking transcatheter aortic valve replacement (TAVR). Renin–angiotensin system (RAS) blockade therapy with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) has recently been associated with improved outcomes after surgical aortic valve replacement and TAVR, but it is unknown if these findings apply to a more rural patient population. Methods: A retrospective cohort study of 169 patients with at least 1 year of post-TAVR follow-up at a single predominantly rural US center was performed to determine if RAS blockade after TAVR affects short- and long-term outcomes. Seventy-one patients were on an ACEI or ARB at the time of TAVR and at 1 year post-TAVR follow-up. Fisher’s exact test was used for categorical data and t-test/ANOVA was used to determine the statistical significance of continuous variables. Results: In a well-matched cohort, RAS blockade therapy post-TAVR was associated with significantly improved overall survival at 2 years (95% vs. 79%, P = 0.042). RAS blockade was also associated with a trend towards decreased heart failure exacerbations in the first year after TAVR, which was statistically significant in the 30 days to 6 months timeframe after TAVR (8% vs. 21%, P = 0.032). Conclusion: In a rural patient population, RAS blockade after TAVR is associated with improved overall survival and a trend towards decreased heart failure exacerbations. This study builds upon previous studies and suggests that TAVR should be considered a compelling indication for these agents.

Heart failure following transcatheter aortic valve replacement

2021 ◽  
pp. 1-15
Author(s):  
Vassili Panagides ◽  
Alberto Alperi ◽  
Jules Mesnier ◽  
Francois Philippon ◽  
Mathieu Bernier ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve

Abstract 15741: Long Term Survival Following Transcatheter Aortic Valve Replacement: Results From a Single US High Volume Center

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ricardo O Escarcega ◽  
Rebecca Torguson ◽  
Marco A Magalhaes ◽  
Nevin C Baker ◽  
Sa’ar Minha ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Term Survival ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Long Term Mortality

Introduction: Mortality following Transcatheter aortic valve replacement (TAVR) has been reported up to 5 years. However, mortality after 5 years remains unclear. Hypothesis: We aim to determine the mortality in patients undergoing TAVR >5 years follow up. Methods: From our institution’s prospectively collected TAVR database we analyzed all patients undergoing TAVR to a maximum follow up of 8 years. We divided our population into transapical TAVR (TA-TAVR) and transfemoral TAVR (TF-TAVR) groups. A Kaplan-Meier survival analysis was conducted. Results: A total of 511 patients who underwent TAVR were included in the analysis. Patients undergoing TA-TAVR had higher rates of peripheral vascular disease compared with TF-TAVR (56% vs 29%, p<0.001) and Society of Thoracic Surgeons Score (10.9 ± 4 vs 9.2 ± 4, p<0.001). TA-TAVR was associated with higher mortality at 1 year (32% vs 21%, p=0.01). However, there was no significant difference in very-long term mortality of patients undergoing TA-TAVR vs TF-TAVR (Figure). Conclusions: Long-term mortality following TAVR surpasses 50%. While in the first 2 years TA-TAVR is associated with higher mortality rates after three years the survival rates are similar in both approaches.

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