Key result
Low energy loss index post-TAVR linked to ~130% higher mortality risk versus high ELI.
Why the study?
As TAVR becomes more widely available, accurate monitoring of postoperative outcomes is needed, prompting evaluation of the link between post-TAVR ELI values and mortality.
Does a low postoperative energy loss index (< 1.34) predict increased all-cause mortality in patients undergoing TAVR?
Cohort
Does a low postoperative energy loss index (< 1.34) predict increased all-cause mortality in patients undergoing TAVR?
A low postoperative energy loss index (< 1.34) is a strong predictor of long-term mortality following transcatheter aortic valve replacement.
Low post-TAVR ELI may flag higher-risk patients for closer surveillance; leaves open whether ELI-guided strategies improve outcomes.
BACKGROUND: As transcatheter aortic valve replacement (TAVR) procedures become more widely available, there is a growing need to monitor and evaluate postoperative outcomes accurately. The energy loss index (ELI) of the ascending aorta has been commonly used to examine the agreement between the echocardiographic and Gorlin measurement of the aortic valve area. OBJECTIVES: This project aims to demonstrate a link between ELI values and mortality following implanted TAVR valves and determine an ELI cutoff value associated with post-TAVR events. METHOD: We retrospectively reviewed patients undergoing TAVR from 2012 to 2017. We calculated ELI values for patients immediately postoperative after a TAVR procedure. Using Receiver-Operator Characteristic and Cox Regression analyses, we identified a cutoff value to distinguish between "High ELI" (≥ 1.34) and "Low ELI" (< 1.34) patients. RESULTS: This study showed low ELI (hazard ratio, 2.30; 95% confidence interval 1.57-3.36, p < .001) as representative of patients with a high risk of mortality post-TAVR. Additionally, post-TAVR, ejection fraction increased by 3.6% (p < .001), and the aortic valve effective orifice area increased by 1.41 cm squared (p < .001) while the mean transvalvular gradient decreased by 32.8 mmHg (p < .001) and the peak transvalvular gradient decreased by 49.0 mmHg (p < .001). CONCLUSION: ELI is an additional prognostic factor that should be considered during risk assessment before TAVR. This study shows that patients with Low ELI had decreased cumulative survival post-TAVR. These patients almost had a fivefold increased risk of death following TAVR.
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Johal et al. (2023) conducted a cohort in Post-transcatheter aortic valve replacement (TAVR). Low Energy Loss Index (< 1.34) vs. High Energy Loss Index (≥ 1.34) was evaluated on All-cause mortality (HR 2.30, 95% CI 1.57-3.36, p=< .001). A low energy loss index (< 1.34) immediately post-TAVR was associated with a significantly higher risk of mortality compared to a high ELI (HR 2.30; 95% CI 1.57-3.36; p < 0.001).
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