Author + information
- Kimi Sato,
- Arnav Kumar,
- Brandon Jones,
- Stephanie Mick,
- Amar Krishnaswamy,
- Richard Grimm,
- Milind Desai,
- Brian Griffin,
- L. Leonardo Rodriguez,
- Samir Kapadia and
- Zoran Popovic
Background: While transcatheter aortic valve replacement (TAVR) improves survival of high risk aortic stenosis (AS) patients, impact of reversibility of LV dysfunction on survival after TAVR is unclear.
Methods: We retrospectively studied 209 consecutive patients (age 81±10 years; 58% males) with AS who underwent TAVR with the Edwards SAPIEN valve. Echocardiographic studies were used to calculate LV end-diastolic volume (EDV), LV ejection fraction (EF) and global longitudinal strain (GLS) before, then immediately (< 10 days), late (1-3 months) and yearly after TAVR.
Results: During median follow-up period of 1148 days (interquartile range: 524 to 1480), 105 (50%) patients died with 25 (12%) dying within 1 year. GLS, LVEDV, LVEF, and LV mass index improved during follow-up (p < 0.001 for all). In patients who died during 1st year, death was preceded by LVEDV increase (p=0.02; Figure 1A). On multivariable stepwise Cox proportional hazards model, a higher STS score (hazard ratio [HR] 1.05, 95%CI: 1.02-1.09, p=0.003), impaired baseline GLS (HR 1.06, 95%CI:1.002-1.11,p=0.043), and smaller indexed EDV decrease at 3 months (HR 1.02, 95%CI: 1.000-1.03, p=0.046) were independently associated with higher mortality. Kaplan Meier curves shows patients with reduced baseline GLS (>-12%) and/or indexed EDV increase at 3 months (>8mL/m2) had poorer survival after TAVR (log-rank test, p=0.01; Figure 1B).
Conclusions: LVEDV decrease, which reflects cardiac plasticity, is associated with better survival after TAVR.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 1:00 p.m.-1:10 p.m.
Session Title: TAVR Outcomes Prognostication
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1221M-07
- 2017 American College of Cardiology Foundation