TY  - BOOK
AU  - Weissman, Neil J
TI  - CT-Defined Prosthesis-Patient Mismatch Downgrades Frequency and Severity, and Demonstrates No Association With Adverse Outcomes After TAVR
SN  - 1936-8798
PY  - 2017///
KW  - *Aortic Valve Stenosis/su [Surgery]
KW  - *Aortic Valve/su [Surgery]
KW  - *Heart Valve Prosthesis
KW  - *Postoperative Complications/dg [Diagnostic Imaging]
KW  - *Tomography, X-Ray Computed
KW  - *Transcatheter Aortic Valve Replacement/is [Instrumentation]
KW  - Aged
KW  - Aged, 80 and over
KW  - Aortic Valve Stenosis/dg [Diagnostic Imaging]
KW  - Aortic Valve Stenosis/mo [Mortality]
KW  - Aortic Valve Stenosis/pp [Physiopathology]
KW  - Aortic Valve/dg [Diagnostic Imaging]
KW  - Aortic Valve/pp [Physiopathology]
KW  - Area Under Curve
KW  - Echocardiography, Doppler
KW  - Female
KW  - Humans
KW  - Hypertrophy, Left Ventricular/dg [Diagnostic Imaging]
KW  - Hypertrophy, Left Ventricular/pp [Physiopathology]
KW  - Kaplan-Meier Estimate
KW  - Male
KW  - Postoperative Complications/mo [Mortality]
KW  - Postoperative Complications/pc [Prevention & Control]
KW  - Postoperative Complications/pp [Physiopathology]
KW  - Predictive Value of Tests
KW  - Prosthesis Design
KW  - Registries
KW  - Reproducibility of Results
KW  - Risk Assessment
KW  - Risk Factors
KW  - ROC Curve
KW  - Severity of Illness Index
KW  - Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
KW  - Transcatheter Aortic Valve Replacement/mo [Mortality]
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online through MWHC library: 2008 - present
N2  - BACKGROUND: PPM does not predict mortality following transcatheter aortic valve replacement (TAVR). However, it is unknown if the EOAi<sub>CT</sub> of the left ventricular outflow tract improves risk stratification; CONCLUSIONS: EOAi<sub>CT</sub> downgrades frequency and severity of PPM in patients after TAVR, and was not associated with mortality 1 year after TAVR. EOAi<sub>TTE</sub>, but not EOAi<sub>CT</sub>, was associated with less left ventricular mass regression. Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved; 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<sup>2</sup>/m<sup>2</sup>), moderate (>=0.65 and <=0.85 cm<sup>2</sup>/m<sup>2</sup>), or severe (<=0.65 cm<sup>2</sup>/m<sup>2</sup>). Correlation of EOAi<sub>CT</sub> and EOAi<sub>TTE</sub> to 1-year outcomes was performed; OBJECTIVES: This study sought to determine if indexed effective orifice area (EOAi), using left ventricular outflow tract measured from computed tomography (EOAi<sub>CT</sub>), reclassified prosthesis-patient mismatch (PPM) compared with conventional echocardiogram-defined measurements (EOAi<sub>TTE</sub>); RESULTS: The incidence of PPM was 24% with EOA<sub>CT</sub> compared with 45% with EOAi<sub>TTE</sub>. Only 6% of PPM was graded severe by EOAi<sub>CT</sub> compared with 9% by EOAi<sub>TTE</sub>. EOAi<sub>TTE</sub>, but not EOAi<sub>CT</sub>, 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<sub>CT</sub> was associated with minor stroke at 1 year (log-rank p = 0.04), and EOAi<sub>TTE</sub> 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
UR  - https://dx.doi.org/10.1016/j.jcin.2017.05.031
ER  -