First description and validation of a new method for estimating aortic stenosis burden and predicting the functional response to TAVI.

Autor:	de la Torre Hernandez JM; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.; Department of Cardiology, Medical School, University of Cantabria, Santander, Spain., Veiga Fernandez G; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain., Ben-Assa E; Cardiology Division, Assuta Ashdod University Hospital, Ben Gurion University, Ashdod, Israel., Iribarren J; School of Mathematics, Universidad de la Laguna, San Cristobal de la Laguna, Spain., Sainz Laso F; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain., Lee DH; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain., Ruisanchez Villar C; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain., Lerena P; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain., Garcia Camarero T; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain., Iribarren Sarrias JL; Intensive Care Unit, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain., Cuesta Cosgaya JM; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain., Maza Fernandez ME; Hydrodynamics and Coastal Infrastructures Group of IH Cantabria, Instituto de Hidraulica Ambiental, Universidad de Cantabria, Santander, Spain., Garilleti C; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain., Fradejas-Sastre V; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain., Benito M; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain., Barrera S; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain., Gil Ongay A; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain., Vazquez de Prada JA; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.; Department of Cardiology, Medical School, University of Cantabria, Santander, Spain., Zueco J; Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2023 Nov 14; Vol. 10, pp. 1215826. Date of Electronic Publication: 2023 Nov 14 (Print Publication: 2023).
DOI:	10.3389/fcvm.2023.1215826
Abstrakt:	Background: Up to one-fifth of patients continue to have poor quality of life after transcatheter aortic valve implantation (TAVI), with an additional similar proportion not surviving 1 year after the procedure. We aimed to assess the value of a new method based on an integrated analysis of left ventricular outflow tract flow velocity and aortic pressure to predict objective functional improvement and prognosis after TAVI. Methods: In a cohort of consecutive patients undergoing TAVI, flow velocity-pressure integrated analysis was obtained from simultaneous pressure recordings in the ascending aorta and flow velocity recordings in the left ventricular outflow tract by echocardiography. Objective functional improvement 6 months after TAVI was assessed through changes in a 6-min walk test and NT-proBNP levels. A clinical follow-up was conducted at 2 years. Results: Of the 102 patients studied, 82 (80.4%) showed objective functional improvement. The 2-year mortality of these patients was significantly lower (9% vs. 44%, p  = 0.001). In multivariate analysis, parameter "(Pressure at Vmax - Pressure at Vo)/Vmax" was found to be an independent predictor for objective improvement. The C-statistic was 0.70 in the overall population and 0.78 in the low-gradient subgroup. All echocardiographic parameters and the valvuloarterial impedance showed a C-statistic of <0.6 for the overall and low-gradient patients. In a validation cohort of 119 patients, the C-statistic was 0.67 for the total cohort and 0.76 for the low-gradient subgroup. Conclusion: This new method allows predicting objective functional improvement after TAVI more precisely than the conventional parameters used to assess the severity of aortic stenosis, particularly in low-gradient patients. Competing Interests: JT received grants/research support from Abbott Medical, Biosensors, Bristol Myers Squibb, and Amgen and received honoraria or consultation fees from Boston Scientific, Medtronic, Biotronik, Astra Zeneca, and Daiichi-Sankyo. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (© 2023 de la Torre Hernandez, Veiga Fernandez, Ben-Assa, Iribarren, Sainz Laso, Lee, Ruisanchez Villar, Lerena, Garcia Camarero, Iribarren Sarrias, Cuesta Cosgaya, Maza Fernandez, Garilleti, Fradejas-Sastre, Benito, Barrera, Gil Ongay, Vazquez de Prada and Zueco.)
Databáze:	MEDLINE
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