Heart failure in severe aortic valve stenosis: prognostic impact of left ventricular ejection fraction and mean gradient on outcome after transcatheter aortic valve implantation

European Journal of Heart Failure - Tập 14 Số 10 - Trang 1155-1162 - 2012
Michael Gotzmann1, Pia Rahlmann1, Tobias Hehnen1, Patrick Müller1, Michael Lindstaedt1, Andreas Mügge1, Aydan Ewers1
1Berufsgenossenschaftliche Kliniken Bergmannsheil, Cardiology and Angiology Ruhr‐University Bochum D‐44789 Bochum Germany

Tóm tắt

AimsThis prospective study aimed to evaluate the prognostic impact of left ventricular ejection fraction (LVEF) and aortic mean gradient patterns on outcome after transcatheter aortic valve implantation (TAVI).Methods and resultsFrom 2008 to 2011, 202 consecutive patients with severe symptomatic aortic valve stenosis (aortic valve area <1.0 cm2) were submitted to TAVI. Patients were divided into four groups according to LVEF (>50% vs. ≤50%) and aortic mean pressure gradient (>40 mmHg vs. ≤40 mmHg): group 1, preserved LVEF/high gradient (n = 86); group 2, preserved LVEF/low gradient (n = 27); group 3, reduced LVEF/high gradient (n = 45); and group 4, reduced LVEF/low gradient (n = 44). A CoreValve prosthesis (Medtronic, Minneapolis, MN, USA) was inserted retrogradely. Echocardiography was performed before and 1 year after TAVI. The primary study endpoint (1‐year all‐cause mortality) was reached in 47 patients (23%). All‐cause mortality was lowest in group 1 (14%), intermediate in group 2 (22%) and group 3 (27%), and highest in group 4 (39%) (P = 0.007). In survivors, aortic mean gradient decreased in all patients (baseline 48 ± 13 mmHg vs. 10 ± 4 mmHg at 1 year, P < 0.001). LVEF improved in group 3 and group 4 (baseline 42 ± 8% vs. 51 ± 11% at 1 year, P < 0.001).ConclusionSevere aortic stenosis with low gradient and/or reduced LVEF is associated with worse outcome after TAVI compared with aortic stenosis with preserved LVEF/high gradient. The evaluation of these haemodynamic parameters may help to improve risk stratification in patients undergoing TAVI.

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Tài liệu tham khảo

Bonow RO, 2006, American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease); Society of Cardiovascular Anesthesiologists. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons, J Am Coll Cardiol, 48, e1

10.1161/01.CIR.62.1.42

10.1161/01.CIR.101.16.1940

10.1016/j.jacc.2009.02.026

10.1016/j.amjcard.2011.11.041

10.1161/CIRCULATIONAHA.106.668681

10.1016/j.jacc.2011.02.059

10.1016/j.jacc.2011.08.072

10.1161/01.CIR.38.1S5.V-61

10.1161/CIRCULATIONAHA.107.698258

10.1016/j.jacc.2007.04.047

10.1056/NEJMoa1202277

10.1056/NEJMoa1200384

10.1056/NEJMoa1114705

10.1093/eurheartj/ehq406

10.1046/j.1540-8167.2004.03625.x

10.1016/j.jacc.2006.03.002

10.1016/S0894-7317(03)00335-3

10.1056/NEJMp030035

10.1093/oxfordjournals.eurheartj.a015209

10.1161/01.CIR.56.6.944

10.1136/hrt.2004.044099

10.1016/j.ahj.2010.09.003

Boon RM, 2012, Clinical outcome following transcatheter aortic valve implantation in patients with impaired left ventricular systolic function, Catheter Cardiovasc Interv, 79, 726

10.1371/journal.pone.0027556

10.1161/CIRCULATIONAHA.110.946533

10.1016/j.jacc.2011.08.050

10.1161/CIRCULATIONAHA.109.929893

10.1093/eurheartj/ehp361

10.1161/CIRCULATIONAHA.110.983510

10.1016/S0735-1097(02)01759-X

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European Journal of Heart Failure

Tập 14 Số 10

1155-1162

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