Key result
Predicted patient-prosthesis mismatch linked to ~88% greater risk of failing to improve NYHA class.
Why the study?
Data regarding the reliability of predicted effective orifice area indexed (pEOAi) in transcatheter aortic valve replacement (TAVR) were scarce, motivating assessment of its validity by correlation with echocardiography-derived hemodynamic data.
Does predicted effective orifice area indexed (pEOAi) correlate with echocardiography-derived hemodynamic data in TAVR patients?
Cohort (n=318)
No
Does predicted effective orifice area indexed (pEOAi) correlate with echocardiography-derived hemodynamic data in TAVR patients?
p-value: p=<0.001
Predicted PPM has an excellent negative predictive value for postprocedural transvalvular mean gradient ≥ 20 mmHg and is a good predictor of NYHA status evolution in TAVR patients.
Supports pEOAi for post-TAVR hemodynamic prediction in observational data; leaves open prospective validation before guiding valve selection.
BACKGROUND: Data regarding the reliability of predicted effective orifice area indexed (pEOAi) is scarce in transcatheter aortic valve replacement (TAVR). AIMS: To assess the validity of the pEOAi in TAVR by correlating its value with echocardiography-derived hemodynamic data. METHODS: A single-center retrospective cohort study of TAVR patients from 2012 to 2021 with available echocardiograms was conducted. Patient-prosthesis mismatch (PPM) was defined based on the Valve Academic Research Consortium 3 criteria. The main endpoints were the congruence of measured effective orifice area indexed (EOAi) and pEOAi with the hemodynamic data obtained by echocardiography. The secondary endpoint included a correlation of predicted PPM (pPPM) and measured PPM (mPPM) with postoperative New York Heart Association (NYHA) status. RESULTS: A total of 318 patients were included. pPPM was more frequent than mPPM (54 [17%]; all moderate PPM vs. 39 [12.3%]: 32 moderate and 7 severe PPM). Predicted and measured EOAi were statistically correlated with postprocedural transvalvular mean gradient and Doppler velocity index (all p < 0.001), including in both sex-based subgroups. The positive predictive value and negative predictive value (NPV) of pPPM for postprocedural transvalvular mean gradient ≥ 20 mmHg were 16% and 97%, respectively. Only pPPM was significantly more prevalent in the group in which NYHA failed to improve than in those with symptom improvement (30.1% vs. 16%, p = 0.027). CONCLUSION: Predicted PPM has an excellent NPV for postprocedural transvalvular mean gradient ≥ 20 mmHg and seems to be a good predictor of NYHA status evolution as opposed to measured PPM. Predicted EOAi can be used in procedural planning to reduce the risk of PPM in both TAVR male and female patients.
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Natalis et al. (2023) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=318). Predicted effective orifice area indexed (pEOAi) and predicted patient-prosthesis mismatch (pPPM) vs. Measured effective orifice area indexed (EOAi) and measured PPM was evaluated on Congruence of measured effective orifice area indexed (EOAi) and pEOAi with the hemodynamic data obtained by echocardiography (p=<0.001). Predicted effective orifice area indexed significantly correlated with postprocedural hemodynamics (p<0.001), and predicted mismatch was associated with lack of NYHA improvement (30.1% vs 16%, p=0.027).
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