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Stroke volume an echocardiographic prognostic marker in patients with high gradient aortic stenosis undergoing transcatheter aortic valve implantation (TAVI)

Session Poster Session 6

Speaker Paul Brennan

Congress : ESC Congress 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Aortic Valve Stenosis
  • Session type : Poster Session
  • FP Number : P5580

Authors : M Alkhalil (Belfast,GB), PB Brennan (Belfast,GB), CM Mcquillan (Belfast,GB), RJ Jeganathan (Belfast,GB), GM Manoharan (Belfast,GB), CO Owens (Belfast,GB), MS Spence (Belfast,GB)

Authors:
M Alkhalil1 , PB Brennan1 , CM Mcquillan1 , RJ Jeganathan1 , GM Manoharan1 , CO Owens1 , MS Spence1 , 1Belfast Health and Social Care Trust - Belfast - United Kingdom of Great Britain & Northern Ireland ,

Citation:

Background: TAVI is currently being evaluated in patients with low surgical risk. Better characterisation of aortic stenosis to reflect the disease process is needed to more precisely identify those who are at increased risk. Indexed stroke volume (SVi) is an echocardiographic measurement that is used for low gradient aortic stenosis.

Purpose:

We studied whether (SVi) is a high-risk marker in high gradient aortic stenosis patients and whether SVi is related to other clinical factors contributing to this risk.

Methods:

699 consecutive patients who underwent TAVI were screened, and only patients with high gradient aortic stenosis were included. A 35 ml/m2 cut-off for SVi was used to define patients with high versus low flow. The primary endpoint was defined as a combination of cardiovascular death and re-admission to hospital with heart failure at 30 days.

Results:

Of the 390 patients with high gradient severe aortic stenosis, 168 (43%) had low flow. They had higher NTproBNP [2578 (1043-5480) vs. 1714 (821-3599) ng/L, P=0.005], and smaller indexed valve area [0.28 (0.23-0.36) vs. 0.35 (0.29-0.42) cm2/m2, P< 0.001]. The primary endpoint was significantly more frequent in low flow compared to high flow patients [8.92% vs. 3.60%, HR 2.54 (95% CI 1.08 to 5.98), P=0.034] (Figure). This was driven mainly by a higher incidence of cardiovascular death [7 (4.2% vs. 0(0%), P= 0.003].

Previous myocardial infarction, CAD, AF, LV impairment, logistic Euroscore, in addition, to low flow were all predictors of 30 days clinical outcomes in an unadjusted model. When all these factors were included in the same adjusted model, only low flow appear to be a predictor of clinical outcomes (HR 2.43, 95% CI 0.86 to 6.64, P= 0.08), although this did not reach statistical significance (Table).

Conclusions:

SVi can further characterise patients with high gradient aortic stenosis and may help to identify those who are at increased risk following TAVI.

HR (unadjusted)

95% CI

P value

HR (adjusted)

95% CI

P value

Low flow

2.54

1.08, 5.98

0.03

2.43

0.86, 6.64

0.08

Previous MI

2.55

1.08, 6.01

0.03

1.88

0.65, 5.45

0.24

AF

2.47

1.09, 5.60

0.03

2.11

0.81, 5.47

0.13

Severe LV impairment

4.68

1.10, 19.96

0.04

1.55

0.20, 12.23

0.68

CAD

2.69

1.16, 6.21

0.02

1.61

0.57, 4.51

0.37

Logistic Euro score

1.04

1.01, 1.07

0.02

1.01

0.98, 1.05

0.47

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