Transcatheter aortic valve replacement in patients with paradoxical low-flow, low-gradient aortic stenosis: Incidence and predictors of treatment futility
| Autor: | Josep Rodés-Cabau, Fabián Islas, Luis Nombela-Franco, Asim N. Cheema, Marina Urena, César Morís, Iria Silva, Henrique Barbosa Ribeiro, Vitor Emer Egypto Rosa, Quentin Fischer, Afonso B. Freitas-Ferraz, Gabriela Veiga, Victoria Vilalta, Siamak Mohammadi, Victor Fradejas-Sastre, Frédéric Maes, Eduard Fernandez-Nofrerias, Philippe Pibarot, Lucia Junquera |
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| Přispěvatelé: | UCL - SSS/IREC/SLUC - Pôle St.-Luc, UCL - (SLuc) Service de pathologie cardiovasculaire |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Preserved left ventricular ejection fraction medicine.medical_treatment 030204 cardiovascular system & hematology Paradoxical low-flow Severity of Illness Index Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Valve replacement Risk Factors Internal medicine medicine Clinical endpoint Humans 030212 general & internal medicine Treatment Futility Aged Aged 80 and over COPD business.industry Incidence (epidemiology) Incidence Atrial fibrillation Aortic Valve Stenosis medicine.disease Transcatheter aortic valve replacement Stenosis Treatment Outcome Heart failure Aortic Valve Cardiology Female Cardiology and Cardiovascular Medicine business Medical Futility Low gradient aortic stenosis |
| Zdroj: | International journal of cardiology, Vol. 316, p. 57-63 (2020) International Journal of Cardiology r-IGTP. Repositorio Institucional de Producción Científica del Instituto de Investigación Germans Trias i Pujol instname |
| ISSN: | 0167-5273 |
| Popis: | Background: Few and controversial data exist on the outcomes of patients with paradoxical low-flow, low-gradient aortic stenosis (PLFLG-AS) following transcatheter aortic valve replacement (TAVR). This study aims to better characterize clinical outcomes and predictors of treatment futility in PLFLG-AS patients undergoing TAVR. Methods: In this multicenter study, 318 patients with PLFLG-AS undergoing TAVR were categorized according to treatment futility, defined as all-cause mortality, poor functional status (NYHA class III-IV) or deterioration in functional class at 1-year follow-up. Clinical outcomes and the factors associated with treatment futility were assessed. Results: The mean age of the patients was 81.0 +/- 8.3 years and 50.3% were women. At 1-year follow-up, 17.6% died and 12.9% had heart failure hospitalization. Residual impaired functional capacity (NYHA = II) was present in 54.4% of patients who were alive at 1-year, and 9.8% remained in NYHA III/IV. The primary endpoint was observed in 103 (32.4%) patients, of which 54% died and 46% had a poor or worsening functional class. Factors independently associated with treatment futility were the presence of atrial fibrillation (AF) (OR:1.79, 95%CI, 1.04-3.10), chronic obstructive pulmonary disease (COPD) (OR:2.66, 95%CI, 1.50-4.74) and a lower SVi (OR per each decrease in 10 ml/m2:1.89, 95%CI, 1.06-3.45). The risk of treatment futility of patients with AF, COPD and a SVi b 30 ml/m2 was 66.38% (95%CI, 54.29%-78.48%). Conclusion: Close to one-third of patientswith PLFLG-AS failed to derive a benefit fromTAVR. The presence of AF, COPD and a low SVi were predictors of treatment futility. Being able to identify patients less likely to improve after the procedure may help to guide management and improve outcomes in patients with PLFLG-AS. (C) 2020 Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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