The prognostic value of low-flow in severe aortic stenosis patients undergoing TAVI - should we follow the flow? Article Swipe
YOU?
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· 2023
· Open Access
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· DOI: https://doi.org/10.1093/ehjci/jead119.178
Funding Acknowledgements Type of funding sources: None. Background Low-flow conditions are associated with higher mortality after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (SAS). Two parameters have been described to determine low-flow status – although the most currently used is stroke volume index, transaortic flow rate (FR – stroke volume divided by left ventricle ejection time) was recently suggested as being superior, as it more closely reflects valvular resistance. Purpose Determine the prognostic impact of low-flow conditions in survival of patients undergoing TAVI for SAS, using low-FR and low-SVi definitions. Methods A database comprising all patients treated with TAVI between 2011 and 2019 in a single-centre was retrospectively analyzed, and cases with echocardiograms performed before intervention in our centre were included. Low-flow patients were defined according to a basal FR<200mL/s or SVi<35mL/m2, and compared with normal counterparts. The prognostic impact of flow was tested using Kaplan-Meier curves, log-rank test and Cox proportional hazard model adjusted for EuroSCORE II, using FR or SVi both as categorical and continuous variables. A subsequent analysis compared patients with preserved and reduced ejection fraction (EF, <52%). Primary endpoint was defined as time to all-cause mortality or last follow-up over the five years after TAVI. Results Of 657 TAVI performed, 490 (74.6%) patients were included in the present analysis, over a median follow-up of 56 months. Of these, 59.6% presented low-FR, and 43.3% had low-SVI. Low-flow patients, using each definition, were of higher estimated surgical risk (EuroSCORE and STS), presented a more advanced NYHA class, had a worse estimated creatinine clearance, and more frequently had coronary disease. Additionally, low-FR patients were older and more frequently female. Atrial fibrillation was more common in low-SVi cases. Echocardiographic studies revealed a lower functional aortic valve area in low-flow cases, and low-SVi was associated with lower transaortic gradients, and lower EF before and after TAVI. Low-FR before TAVI was associated with higher mortality over follow-up [Hazard Ratio (HR) 1.43 (1.06–1.92), p = 0.019)], even after adjusting for EuroSCORE II [HR 1.39 (1.03–1.90), p = 0.034], which was not observed for low-SVi (p = 0.06 and p = 0.2 for uni- and multivariable analysis, respectively). When analyzing FR and SVi as continuous variables, a higher SVi, but not FR, was associated with improved survival [HR 0.98 (0.97–1.00), p = 0.018; HR 0.99 (0.97–1.00), p = 0.044 for uni- and multivariable analysis, respectively). When stratifying by preserved or reduced EF, both FR and SVi did not predict mortality. Conclusions About half of SAS patients undergoing TAVI present with a low-flow condition, which is frequently associated with more advanced heart failure symptoms and higher estimated surgical risk. Low-FR negatively impacts survival after intervention. SVi is also prognostic, but not at a <35ml/s cut-off.
Related Topics
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1093/ehjci/jead119.178
- https://academic.oup.com/ehjcimaging/article-pdf/24/Supplement_1/jead119.178/50622789/jead119.178.pdf
- OA Status
- bronze
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4381125385
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4381125385Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1093/ehjci/jead119.178Digital Object Identifier
- Title
-
The prognostic value of low-flow in severe aortic stenosis patients undergoing TAVI - should we follow the flow?Work title
- Type
-
articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2023Year of publication
- Publication date
-
2023-06-01Full publication date if available
- Authors
-
Diogo Santos‐Ferreira, Sílvia O. Diaz, Iolanda Conde Fernandes, Cláudio Guerreiro, M Brandao, Ricardo Henrique de Oliveira Braga Teixeira, F Nunes, Eulália Pereira, Francisco Sampaio, Gustavo Pires‐Morais, Bruno Melica, Luciane Loures dos Santos, Alberto Rodrigues, Pedro Braga, Ricardo Fontes‐CarvalhoList of authors in order
- Landing page
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https://doi.org/10.1093/ehjci/jead119.178Publisher landing page
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https://academic.oup.com/ehjcimaging/article-pdf/24/Supplement_1/jead119.178/50622789/jead119.178.pdfDirect link to full text PDF
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YesWhether a free full text is available
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bronzeOpen access status per OpenAlex
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https://academic.oup.com/ehjcimaging/article-pdf/24/Supplement_1/jead119.178/50622789/jead119.178.pdfDirect OA link when available
- Concepts
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Medicine, Cardiology, Internal medicine, Stenosis, Ejection fraction, Stroke volume, Proportional hazards model, Hazard ratio, Ventricle, Log-rank test, Aortic valve stenosis, Stroke (engine), Aortic valve, Heart failure, Surgery, Confidence interval, Engineering, Mechanical engineeringTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.follow-up | 195, 219, 317 |
| abstract_inverted_index.included. | 123 |
| abstract_inverted_index.mortality | 15, 192, 315 |
| abstract_inverted_index.patients, | 233 |
| abstract_inverted_index.performed | 116 |
| abstract_inverted_index.presented | 226, 246 |
| abstract_inverted_index.preserved | 177, 397 |
| abstract_inverted_index.suggested | 61 |
| abstract_inverted_index.superior, | 64 |
| abstract_inverted_index.ventricle | 56 |
| abstract_inverted_index.(EuroSCORE | 243 |
| abstract_inverted_index.Background | 8 |
| abstract_inverted_index.associated | 12, 296, 312, 372, 425 |
| abstract_inverted_index.clearance, | 257 |
| abstract_inverted_index.comprising | 96 |
| abstract_inverted_index.condition, | 421 |
| abstract_inverted_index.conditions | 10, 79 |
| abstract_inverted_index.continuous | 169, 363 |
| abstract_inverted_index.creatinine | 256 |
| abstract_inverted_index.frequently | 260, 271, 424 |
| abstract_inverted_index.functional | 286 |
| abstract_inverted_index.gradients, | 300 |
| abstract_inverted_index.mortality. | 408 |
| abstract_inverted_index.negatively | 438 |
| abstract_inverted_index.parameters | 28 |
| abstract_inverted_index.performed, | 206 |
| abstract_inverted_index.prognostic | 75, 141 |
| abstract_inverted_index.subsequent | 172 |
| abstract_inverted_index.undergoing | 84, 415 |
| abstract_inverted_index.variables, | 364 |
| abstract_inverted_index.variables. | 170 |
| abstract_inverted_index.Conclusions | 409 |
| abstract_inverted_index.categorical | 167 |
| abstract_inverted_index.definition, | 236 |
| abstract_inverted_index.prognostic, | 446 |
| abstract_inverted_index.resistance. | 71 |
| abstract_inverted_index.stratifying | 395 |
| abstract_inverted_index.transaortic | 46, 299 |
| abstract_inverted_index.Kaplan-Meier | 148 |
| abstract_inverted_index.definitions. | 92 |
| abstract_inverted_index.fibrillation | 274 |
| abstract_inverted_index.implantation | 20 |
| abstract_inverted_index.intervention | 118 |
| abstract_inverted_index.proportional | 154 |
| abstract_inverted_index.&lt;52%). | 183 |
| abstract_inverted_index.Additionally, | 264 |
| abstract_inverted_index.counterparts. | 139 |
| abstract_inverted_index.intervention. | 442 |
| abstract_inverted_index.multivariable | 354, 391 |
| abstract_inverted_index.single-centre | 108 |
| abstract_inverted_index.transcatheter | 17 |
| abstract_inverted_index.&lt;35ml/s | 451 |
| abstract_inverted_index.(0.97–1.00), | 378, 384 |
| abstract_inverted_index.(1.03–1.90), | 334 |
| abstract_inverted_index.(1.06–1.92), | 322 |
| abstract_inverted_index.respectively). | 356, 393 |
| abstract_inverted_index.echocardiograms | 115 |
| abstract_inverted_index.retrospectively | 110 |
| abstract_inverted_index.Acknowledgements | 2 |
| abstract_inverted_index.Echocardiographic | 281 |
| abstract_inverted_index.FR&lt;200mL/s | 132 |
| abstract_inverted_index.SVi&lt;35mL/m2, | 134 |
| cited_by_percentile_year | |
| countries_distinct_count | 1 |
| institutions_distinct_count | 15 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.8399999737739563 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.18569992 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |