Key result
Low ejection fraction, low gradient severe aortic stenosis was associated with significantly higher all-cause mortality after TAVI (HR 2.86, p=0.003).
Why the study?
Do guideline-defined subtypes of severe aortic stenosis predict long-term outcomes after TAVI?
Cohort (n=400)
No
Do guideline-defined subtypes of severe aortic stenosis predict long-term outcomes after TAVI?
Hazard Ratio: 2.86
p-value: p=0.003
In patients undergoing TAVI, the guideline-defined subtype of aortic stenosis, particularly low ejection fraction-low gradient (LEF-LG), is a stronger predictor of long-term mortality and MACCE than ejection fraction alone.
LEF-LG severe AS signals higher post-TAVI mortality; leaves open whether subtypes should guide management.
AIMS: The objective of this study was to examine the impact of guideline-defined subtypes of severe aortic stenosis (AS) on long-term outcomes after TAVI. METHODS AND RESULTS: Four hundred (400) consecutive patients who underwent TAVI (203 transapical, 197 transfemoral) at our institution 8/2008-3/2013 were followed systematically (for up to seven years). One hundred and forty-seven (147) individuals suffered from NEF-HG AS (LV-EF ≥50%, high Pmean ≥40 mmHg), 63 from LEF-HG AS (LV-EF <50%, high gradient), 77 from PLF-LG AS (LV-EF ≥50%, low gradient, stroke volume index [SVI] <35 ml/m²), and 81 from LEF-LG AS (LV-EF <50%, low gradient). LEF-LG status was associated with the highest all-cause and cardiovascular mortality and MACCE rate, whereas NEF-HG patients exhibited the best outcome (i.e., median survival 5.1 years in NEF-HG vs. 1.3 years in LEF-LG, p=0.0006; or vs. 3.3 years in PLF-LG, p=0.02). In multivariate analysis, LEF-LG status emerged as the outcome predictor with the highest hazard ratio for all-cause mortality (HR 2.86, p=0.003), cardiovascular mortality (HR 6.53, p<0.0001), and MACCE (HR 2.44, p=0.007), whereas neither baseline EF nor SVI <35 ml/m² independently predicted these endpoints. CONCLUSIONS: These findings suggest that an assessment of LV-EF alone for outcome prediction after TAVI is inadequate; it is the guideline-defined subtype of AS that determines outcome.
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Puls et al. (2017) conducted a cohort in Severe aortic stenosis (n=400). Low ejection fraction, low gradient (LEF-LG) severe aortic stenosis vs. Normal ejection fraction, high gradient (NEF-HG) severe aortic stenosis was evaluated on All-cause mortality (HR 2.86, p=0.003). Low ejection fraction, low gradient severe aortic stenosis was associated with significantly higher all-cause mortality after TAVI (HR 2.86, p=0.003).
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