Role of contractile reserve as a predictor of mortality in low-flow, low-gradient severe aortic stenosis following transcatheter aortic valve replacement.

MedStar author(s):
Citation: Catheterization & Cardiovascular Interventions. 93(4):707-712, 2019 03 01.PMID: 30280469Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve Stenosis/su [Surgery] | *Aortic Valve/su [Surgery] | *Hemodynamics | *Myocardial Contraction | *Transcatheter Aortic Valve Replacement/mo [Mortality] | *Ventricular Dysfunction, Left/pp [Physiopathology] | *Ventricular Function, Left | Aged | Aged, 80 and over | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/pp [Physiopathology] | Databases, Factual | Female | Humans | Male | Recovery of Function | Retrospective Studies | Risk Assessment | Risk Factors | Severity of Illness Index | Stroke Volume | Time Factors | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Treatment Outcome | Ventricular Dysfunction, Left/dg [Diagnostic Imaging] | Ventricular Dysfunction, Left/mo [Mortality]Year: 2019Local holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006ISSN:
  • 1522-1946
Name of journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & InterventionsAbstract: BACKGROUND: Patients with severe AS, left ventricular dysfunction, and low transaortic gradient are at high risk for mortality during surgical aortic valve replacement (SAVR). Furthermore, patients without CR have been shown to have perioperative mortality comparable to that of patients treated medically for severe AS.CONCLUSION: In patients with low-flow, low-gradient severe AS undergoing TAVR, the presence or absence of CR does not predict all-cause mortality at 30 days or 1 year.Copyright (c) 2018 Wiley Periodicals, Inc.METHODS: We retrospectively analyzed patients who underwent TAVR with a diagnosis of low-gradient severe AS (mean transvalvular aortic gradient < 40 mmHg, LVEF < 50%, and AVA <= 1.0 cm<sup>2</sup> or AVAi <= 0.6 cm<sup>2</sup> ) and who had a pre-TAVR dobutamine stress echocardiogram (DSE). Patients were stratified by the presence or absence of CR, defined as an increase in stroke volume >= 20% during DSE.OBJECTIVES: The aim of this study was to determine the prognostic value of contractile reserve (CR) at baseline in patients with low-flow, low-gradient severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).RESULTS: From 2008 to 2016, 61 patients with low-gradient severe AS underwent TAVR and had pre-TAVR DSE. CR was present in 31 patients (51%) and absent in 30 (49%). There was no significant difference between the two groups in baseline demographics, medical history, access site, or types of valves. All-cause mortality was similar in both groups at 30 days (13% with CR vs 10% without CR, P = 1.00) and 1 year (29% with CR vs 33% without CR, HR 1.20, 95% CI 0.49-2.96, P = 0.69).All authors: Asch FM, Ben-Dor I, Buchanan KD, Koifman E, Okubagzi PG, Pichard AD, Rogers T, Satler LF, Shults C, Steinvil A, Torguson R, Waksman R, Xu LOriginally published: Catheterization & Cardiovascular Interventions. 2018 Oct 02Fiscal year: FY2019Digital Object Identifier: Date added to catalog: 2018-10-10
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Journal Article MedStar Authors Catalog Article 30280469 Available 30280469

Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006

BACKGROUND: Patients with severe AS, left ventricular dysfunction, and low transaortic gradient are at high risk for mortality during surgical aortic valve replacement (SAVR). Furthermore, patients without CR have been shown to have perioperative mortality comparable to that of patients treated medically for severe AS.

CONCLUSION: In patients with low-flow, low-gradient severe AS undergoing TAVR, the presence or absence of CR does not predict all-cause mortality at 30 days or 1 year.

Copyright (c) 2018 Wiley Periodicals, Inc.

METHODS: We retrospectively analyzed patients who underwent TAVR with a diagnosis of low-gradient severe AS (mean transvalvular aortic gradient < 40 mmHg, LVEF < 50%, and AVA <= 1.0 cm<sup>2</sup> or AVAi <= 0.6 cm<sup>2</sup> ) and who had a pre-TAVR dobutamine stress echocardiogram (DSE). Patients were stratified by the presence or absence of CR, defined as an increase in stroke volume >= 20% during DSE.

OBJECTIVES: The aim of this study was to determine the prognostic value of contractile reserve (CR) at baseline in patients with low-flow, low-gradient severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).

RESULTS: From 2008 to 2016, 61 patients with low-gradient severe AS underwent TAVR and had pre-TAVR DSE. CR was present in 31 patients (51%) and absent in 30 (49%). There was no significant difference between the two groups in baseline demographics, medical history, access site, or types of valves. All-cause mortality was similar in both groups at 30 days (13% with CR vs 10% without CR, P = 1.00) and 1 year (29% with CR vs 33% without CR, HR 1.20, 95% CI 0.49-2.96, P = 0.69).

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