Author + information
- Ajayram Ullal,
- Polydoros Kampaktsis,
- Rajesh Swaminathan,
- Shing-Chiu Wong,
- Robert Minutello,
- Dmitriy Feldman,
- Geoffrey Bergman,
- Luke Kim,
- Harsimran Singh and
- Peter Okin
Background: Electrocardiographic (ECG) left ventricular hypertrophy (LVH) has previously been associated with increased mortality in patients with asymptomatic aortic stenosis and hypertension. However, its prognostic role in patients undergoing transcatheter aortic valve replacement (TAVR) is unclear.
Methods: We examined 231 patients (96 men; mean age 84.7±7.8 years) undergoing TAVR. Cornell voltage (SV3+RaVL >28 mm in men and >20 mm in women) defined LVH. Kaplan-Meier analysis was used to derive survival curves and Cox regression to compare survival among the groups.
Results: Mean follow-up was 16.3±10.4 months. Patients without ECG LVH had lower mean aortic valve gradients (MAVG) and higher rate of myocardial infarctions at baseline. The rates of low-flow low-gradient aortic stenosis and post-TAVR complications including aortic insufficiency were similar among the groups. The absence of ECG LVH was significantly associated with increased mortality even after adjusting for MAVG and other baseline predictors of mortality in this population (lung disease, pre-TAVR atrial fibrillation or flutter, serum creatinine >1.5 mg/dL, prior stroke and baseline hemoglobin) (40.4% vs. 23.6% at 2-years, HR = 1.85, CI 95% 1.08–3.16, p=.026, Figure).
Conclusions: Baseline absence of ECG LVH was associated with increased mortality in patients undergoing TAVR. Another process such as myocardial fibrosis or amyloidosis may be responsible for this higher mortality in TAVR patients with lower ECG voltages.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Interventional Cardiology: TAVR 1
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1114-163
- 2017 American College of Cardiology Foundation