Author + information
- Jamie Michael O'Driscoll,
- Angela Gravina,
- Sara Di Fino,
- Matt Thompson,
- Alan Karthikesalingam,
- Kausik Ray and
- Rajan Sharma
Transthoracic echocardiography (TTE) is routinely requested as part of the clinical assessment of patients awaiting endovascular repair of the abdominal aorta (EVAR). However, the long–term prognostic value of this imaging modality is unclear. The aim of this study was to assess pre–operative echocardiographic predictors for all–cause mortality in a group of patients undergoing EVAR.
Two hundred and seventy three patients who underwent EVAR were studied. All patients had a TTE prior to the procedure. Patients were prospectively analyzed and the main outcome measure was all–cause mortality.
One patient died during the procedure and over a mean follow up of 1.8±0.8 years there were 52 (19%) deaths with a mean time to death of 0.7±0.3 years. The only clinical parameter significantly associated with all–cause mortality was heart failure (11.5 vs 1.4%, p<0.001). Of the echo parameters, patients that died had significantly greater left ventricular (LV) end systolic diameter (3.47±0.8 vs 3.11±0.7 cm, p=0.004), LV end diastolic diameter (5.11±0.7 vs 4.83±0.6 cm, p=0.009), pulmonary artery pressure (PAP) (39.1±16.8 vs 33.9±9.9 mmHg, p=0.028), ascending aortic diameter (3.88±0.7 vs 3.52±0.5 cm, p=0.032) and significantly lower LV fractional shortening (59±12 vs 62±12%, p=0.036). A greater proportion of patients who died had resting wall motion abnormalities (40.4 vs 19.9%, p=0.001), mitral regurgitation (MR) (55.8 vs 35.3%, p=0.023), tricuspid regurgitation (26.9 vs 20.8%, p=0.033), and PAP >35 mmHg (42.3 vs 22.2%, p=0.017). With multivariate regression analysis, a greater ascending aortic diameter (HR 3.46, 95% CI 1.21–9.87, p=0.02) and MR (HR 2.15, 95% CI 2.03–2.74, p=0.02) were the only independent predictors of total mortality.
Echocardiography provides important long–term prognostic information in patients undergoing EVAR. These echo indices were more important at predicting outcome than standard conventional risk factors in this patient group. A greater ascending aortic diameter and presence of MR were independently associated with all–cause mortality.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Vascular Medicine: Endovascular Therapy III
Abstract Category: 34. Vascular Medicine: Endovascular Therapy
Presentation Number: 1253–165
- 2013 American College of Cardiology Foundation