Impact of mitral regurgitation on clinical outcomes of patients with low-ejection fraction, low-gradient severe aortic stenosis undergoing transcatheter aortic valve implantation
| Autor: | Peter Wenaweser, Bernhard Meier, Ahmed A. Khattab, Thierry Carrel, Christoph Huber, Thomas Pilgrim, Thomas Zanchin, Lutz Buellesfeld, Stephan Zbinden, Anne Bütikofer, Crochan J. O'Sullivan, Stephan Windecker, Stefan Stortecky, Stefan Blöchlinger, Fabien Praz, Dik Heg |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Cardiac Catheterization Time Factors animal structures 610 Medicine & health Kaplan-Meier Estimate macromolecular substances Risk Assessment Ventricular Function Left Risk Factors 360 Social problems & social services Internal medicine Cardiac Catheterization/adverse effects/methods/mortality medicine Clinical endpoint Humans Aortic Valve Stenosis/complications/diagnosis/mortality/physiopathology/therapy Heart Valve Prosthesis Implantation/adverse effects/methods/mortality Aged Proportional Hazards Models Aged 80 and over Heart Valve Prosthesis Implantation Mitral regurgitation Ejection fraction business.industry Patient Selection Hazard ratio Mitral Valve Insufficiency Stroke Volume Aortic Valve Stenosis medicine.disease Mitral Valve Insufficiency/complications/diagnosis/mortality/physiopathology/therapy Confidence interval Surgery Stenosis Treatment Outcome Concomitant Aortic valve stenosis Cardiology cardiovascular system Female Cardiology and Cardiovascular Medicine business Switzerland |
| Zdroj: | O'Sullivan, Crochan J; Stortecky, Stefan; Bütikofer, Anne; Heg, Dik; Zanchin, Thomas; Huber, Christoph; Pilgrim, Thomas; Praz, Fabien; Büllesfeld, Lutz; Khattab, Ahmed Aziz; Blöchlinger, Stefan; Carrel, Thierry; Meier, Bernhard; Zbinden, Stephan; Wenaweser, Peter Martin; Windecker, Stephan (2015). Impact of mitral regurgitation on clinical outcomes of patients with low-ejection fraction, low-gradient severe aortic stenosis undergoing transcatheter aortic valve implantation. Circulation: Cardiovascular interventions, 8(2), e001895. Lippincott Williams & Wilkins 10.1161/CIRCINTERVENTIONS.114.001895 Circulation. Cardiovascular Interventions, Vol. 8, No 2 (2015) P. e001895 |
| ISSN: | 1941-7640 |
| DOI: | 10.7892/boris.63518 |
| Popis: | Background— Up to 1 in 6 patients undergoing transcatheter aortic valve implantation (TAVI) present with low-ejection fraction, low-gradient (LEF-LG) severe aortic stenosis and concomitant relevant mitral regurgitation (MR) is present in 30% to 55% of these patients. The effect of MR on clinical outcomes of LEF-LG patients undergoing TAVI is unknown. Methods and Results— Of 606 consecutive patients undergoing TAVI, 113 (18.7%) patients with LEF-LG severe aortic stenosis (mean gradient ≤40 mm Hg, aortic valve area 2 , left ventricular ejection fraction P =0.76). At 1 year, LEF-LG patients with ≥moderate MR had an adjusted 3-fold higher rate of all-cause mortality (11.5% versus 38.1%; adjusted hazard ratio, 3.27 [95% confidence interval, 1.31–8.15]; P =0.011), as compared with LEF-LG patients with ≤mild MR. Mortality was mainly driven by cardiac death (adjusted hazard ratio, 4.62; P =0.005). As compared with LEF-LG patients with ≥moderate MR assigned to medical therapy, LEF-LG patients with ≥moderate MR undergoing TAVI had significantly lower all-cause mortality (hazard ratio, 0.38; 95% confidence interval, 0.019–0.75) at 1 year. Conclusions— Moderate or severe MR is a strong independent predictor of late mortality in LEF-LG patients undergoing TAVI. However, LEF-LG patients assigned to medical therapy have a dismal prognosis independent of MR severity suggesting that TAVI should not be withheld from symptomatic patients with LEF-LG severe aortic stenosis even in the presence of moderate or severe MR. |
| Databáze: | OpenAIRE |
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