TY - JOUR
T1 - Comparison of Different Invasive Hemodynamic Measurements as a Prediction Tool for Mortality after Transcatheter Aortic Valve Replacement in Men
T2 - A Retrospective Observational Study
AU - Bavry, Anthony A.
AU - Aalaei-Andabili, Seyed H.
AU - Karimi, Ashkan
AU - Park, Ki
AU - Choi, Calvin Y.
AU - Manning, Eddie W.
AU - Beaver, Thomas M.
AU - Stinson, Wade W.
N1 - Publisher Copyright:
© 2017, The Author(s).
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Introduction: Hemodynamic measurements can assess for paravalvular aortic regurgitation after transcatheter aortic valve replacement (TAVR). This study compared the utility of different invasive hemodynamic measures in providing prognostic information. Methods: This retrospective observational study of TAVR patients at a Veterans Hospital assessed aortic regurgitation index, diastolic delta, pulse pressure, and heart rate adjusted diastolic delta obtained at valve implantation. The primary outcome was total mortality. Results: Overall, 151 patients underwent TAVR. Immediately after implantation, mean aortic regurgitation index was 31 ± 8.6, mean diastolic delta was 38 ± 9.8 mmHg, mean pulse pressure was 67 ± 18 mmHg, and mean heart rate adjusted diastolic delta was 47 ± 14.3 mmHg/beats per minute. Two percent of patients had ≥ moderate paravalvular aortic regurgitation by postoperative transthoracic echocardiography. Total mortality was 15.2% at a mean follow-up of 12.7 ± 9.2 months. Aortic regurgitation index <25 vs. ≥25, diastolic delta <19 vs. ≥19 mmHg, and pulse pressure >60 vs. ≤60 mmHg were not associated with total mortality. However, total mortality was 50% for heart rate adjusted diastolic delta <25 mmHg/beats per minute vs. 12.6% for heart rate adjusted diastolic delta ≥25 mmHg/beats per minute (p = 0.017). In a multivariate Cox regression analysis, heart rate adjusted diastolic delta <25 mmHg/beats per minute vs. heart rate adjusted diastolic delta ≥25 mmHg/beats per minute was associated with total mortality (hazard ratio 9.4, 95% confidence interval 2.0–44, p = 0.004). Conclusions: Among a cohort of TAVR patients, the only invasive hemodynamic test independently associated with total mortality was heart rate adjusted diastolic delta.
AB - Introduction: Hemodynamic measurements can assess for paravalvular aortic regurgitation after transcatheter aortic valve replacement (TAVR). This study compared the utility of different invasive hemodynamic measures in providing prognostic information. Methods: This retrospective observational study of TAVR patients at a Veterans Hospital assessed aortic regurgitation index, diastolic delta, pulse pressure, and heart rate adjusted diastolic delta obtained at valve implantation. The primary outcome was total mortality. Results: Overall, 151 patients underwent TAVR. Immediately after implantation, mean aortic regurgitation index was 31 ± 8.6, mean diastolic delta was 38 ± 9.8 mmHg, mean pulse pressure was 67 ± 18 mmHg, and mean heart rate adjusted diastolic delta was 47 ± 14.3 mmHg/beats per minute. Two percent of patients had ≥ moderate paravalvular aortic regurgitation by postoperative transthoracic echocardiography. Total mortality was 15.2% at a mean follow-up of 12.7 ± 9.2 months. Aortic regurgitation index <25 vs. ≥25, diastolic delta <19 vs. ≥19 mmHg, and pulse pressure >60 vs. ≤60 mmHg were not associated with total mortality. However, total mortality was 50% for heart rate adjusted diastolic delta <25 mmHg/beats per minute vs. 12.6% for heart rate adjusted diastolic delta ≥25 mmHg/beats per minute (p = 0.017). In a multivariate Cox regression analysis, heart rate adjusted diastolic delta <25 mmHg/beats per minute vs. heart rate adjusted diastolic delta ≥25 mmHg/beats per minute was associated with total mortality (hazard ratio 9.4, 95% confidence interval 2.0–44, p = 0.004). Conclusions: Among a cohort of TAVR patients, the only invasive hemodynamic test independently associated with total mortality was heart rate adjusted diastolic delta.
KW - Aortic regurgitation
KW - Aortic stenosis
KW - Hemodynamic assessment
KW - TAVR
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U2 - 10.1007/s40119-017-0095-5
DO - 10.1007/s40119-017-0095-5
M3 - Article
C2 - 28667514
AN - SCOPUS:85118092458
SN - 2193-8261
VL - 6
SP - 251
EP - 259
JO - Cardiology and Therapy
JF - Cardiology and Therapy
IS - 2
ER -