Author + information
- Salim Hayek,
- Mahmoud Abdou,
- Vasilis Babaliaros,
- Vinod Thourani,
- Emir Veledar,
- Sharon Howell and
- Stamatios Lerakis
Patients with severe aortic stenosis and low mean transvalvular gradient have poor outcomes, with an estimated 30 day post–surgical Aortic Valve Replacement (AVR) mortality of 21%. Low Dose Dobutamine Stress Echocardiography (LD–DSE) is performed in these patients for further risk stratification by determining the presence of contractile reserve (CR) – defined as an at least 20% increase in stroke volume with Dobutamine infusion. Patients with CR have lower mortality. However, it is unclear if LD–DSE can predict outcomes in patients with low gradient aortic stenosis (LGAS) undergoing Transcatheter Aortic Valve Replacement (TAVR).
We retrospectively identified all patients with a resting mean aortic valve gradient < 40 mmHg, who underwent TAVR at Emory University Hospital, and had a pre–procedural LD–DSE. Patients were grouped according to the presence or absence of CR as defined above. Outcomes identified in these patients after TAVR include re–hospitalizations and mortality at 30 days, 6 months and one year.
Forty–two patients were identified, of which 36 (85.7%) were white, 28 (66%) were male, and the average age was 79.8±8.2. The prevalence of coronary artery disease in this cohort was 81.0%. Two–thirds of patients had a low ejection fraction (<40%) at baseline, and 15 patients (35.7%) had CR by LD–DSE. Median follow–up time was 183.5 days. By 30 days post–TAVR, 6 patients (14.3%) died; of which only 1 patient (7.1%) had CR and 5 (20.0%) did not. Six month and 1 year mortality were 20% and 33.3% respectively, with no differences between patients with and without reserve. There were no significant differences in re–hospitalization rates at 30 days (8.1%), 6 months (25.9%), and at one year (46.7%) between patients with and without reserve.
In this retrospective study of patients with LGAS undergoing TAVR, the absence of CR on LD–DSE portended increased mortality at 30 days post–TAVR. However the difference was not statistically significant given the small sample size and low number of outcomes. Larger studies with longer follow–up are needed confirm or deny a role for LD–DSE in the risk–stratification of patients with LGAS undergoing TAVR.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: TAVR I: Predictors of TAVR Outcomes Including LVEF, Contractile Reserve, BNP, Pulmonary HTN, CA 125, and Fever
Abstract Category: 32. Valvular Heart Disease: Therapy
Presentation Number: 1156M–85
- 2013 American College of Cardiology Foundation