Predictors of 6-month poor clinical outcomes after transcatheter aortic valve implantation
| Autor: | Hervé Le Breton, Marc Bedossa, M. Laurent, Xavier Beneux, Dominique Boulmier, Jean-Philippe Verhoye, Vincent Auffret, Emmanuel Oger, Erwan Donal, Majid Harmouche, Gwenaelle Sost |
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| Přispěvatelé: | Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Pharmacologie [Rennes], Service de gériatrie, Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Senhadji, Lotfi |
| Jazyk: | angličtina |
| Předmět: |
Male
Aortic valve Cardiac Catheterization Time Factors Ventricular Dysfunction Right 030204 cardiovascular system & hematology Severity of Illness Index 0302 clinical medicine Risk Factors Sténose aortique Atrial Fibrillation Odds Ratio Clinical endpoint Prospective Studies 030212 general & internal medicine Stroke Aged 80 and over Heart Valve Prosthesis Implantation education.field_of_study Framingham Risk Score Ejection fraction Atrial fibrillation General Medicine [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system 3. Good health Treatment Outcome medicine.anatomical_structure Cardiology Female [SDV.IB]Life Sciences [q-bio]/Bioengineering Cardiology and Cardiovascular Medicine medicine.medical_specialty Résultat Hypertension Pulmonary Aortic Valve Insufficiency Population Aortic regurgitation Outcomes Patient Readmission 03 medical and health sciences [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system Internal medicine medicine Humans Insuffisance aortique education Aged Proportional Hazards Models [SDV.IB] Life Sciences [q-bio]/Bioengineering Heart Failure Transcatheter aortic valve implantation Chi-Square Distribution business.industry Patient Selection Aortic stenosis Aortic Valve Stenosis medicine.disease Logistic Models Valve aortique percutanée Heart failure Multivariate Analysis business |
| Zdroj: | Archives of cardiovascular diseases Archives of cardiovascular diseases, Elsevier/French Society of Cardiology, 2014, 107 (1), pp.10-20. ⟨10.1016/j.acvd.2013.10.005⟩ Archives of cardiovascular diseases, 2014, 107 (1), pp.10-20. ⟨10.1016/j.acvd.2013.10.005⟩ |
| ISSN: | 1875-2136 1875-2128 |
| DOI: | 10.1016/j.acvd.2013.10.005 |
| Popis: | International audience; BACKGROUND: Patient selection for transcatheter aortic valve implantation (TAVI) remains a major concern. Indeed, despite promising results, it is still unclear which patients are most and least likely to benefit from this procedure. AIMS: To identify predictors of 6-month poor clinical outcomes after TAVI. METHODS: Patients who were discharged from our institution with a transcatheter-implanted aortic valve were followed prospectively. Our population was divided into two groups ('good outcomes' and 'poor outcomes') according to occurrence of primary endpoint (composite of all-cause mortality, all stroke, hospitalizations for valve-related symptoms or worsening heart failure from discharge to 6 months or 6-month New York Heart Association functional class III or IV). Patient characteristics were studied to find predictors of poor outcomes. RESULTS: We included 163 patients (mean age, 79.9 ± 8.8 years; 90 men [55%]; mean logistic EuroSCORE, 18.4 ± 11.4%). The primary endpoint occurred in 49 patients (mean age, 83 ± 5 years; 31 men [63%]). By multivariable analysis, atrial fibrillation (odds ratio [OR] 3.94), systolic pulmonary artery pressure ≥60 mmHg (OR 7.56) and right ventricular dysfunction (OR 3.55) were independent predictors of poor outcomes, whereas baseline aortic regurgitation ≥2/4 (OR 0.07) demonstrated a protective effect. CONCLUSION: Atrial fibrillation, severe baseline pulmonary hypertension and right ventricular dysfunction (i.e. variables suggesting a more evolved aortic stenosis) were predictors of 6-month poor outcomes. Conversely, baseline aortic regurgitation ≥2/4 showed a protective effect, which needs to be confirmed in future studies. Our study highlights the need for a specific 'TAVI risk score', which could lead to better patient selection. |
| Databáze: | OpenAIRE |
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