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A new integrative approach to assess aortic stenosis burden and predict objective functional improvement after TAVR

Abstract: Background: A non-negligible rate of patients undergoing transcatheter aortic valve replacement (TAVR) do not report symptomatic improvement or even die in the short-midterm. We sought to assess the degree of objective functional recovery after TAVR and its prognostic implications and to develop a predictive model. Methods: In a cohort of patients undergoing TAVR, a prospective evaluation of clinical, anatomical, and physiological parameters was conducted before and after the procedure. These parameters were derived from echocardiography, non-invasive analysis of arterial pulse waves, and cardiac tomography. Objective functional improvement 6 months after TAVR was assessed using a 6-min walk test and nitro-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The derived predictive model was prospectively validated in a different cohort. A clinical follow-up was conducted at 2 years. Results: Among the 212 patients included, objective functional improvement was observed in 169 patients (80%) and subjective improvement in 187 (88%). Patients with objective functional improvement showed a much lower death rate at 2 years (9% vs. 31% p = 0.0002). Independent predictors of improvement were as follows: mean aortic gradient of ?40 mmHg, augmentation index75 of ?45%, the posterior wall thickness of ?12 mm, and absence of atrial fibrillation. A simple integer-based point score was developed (GAPA score), which showed an area under the curve of 0.81 for the overall cohort and 0.78 for the low-gradient subgroup. In a validation cohort of 216 patients, these values were 0.75 and 0.76, respectively. Conclusion: A total of 80% of patients experienced objective functional improvement after TAVR, showing a significantly lower 2-year mortality rate. A predictive score was built that showed a good discriminative performance in overall and low-gradient populations.

Otras publicaciones de la misma revista o congreso con autores/as de la Universidad de Cantabria

 Fuente: Frontiers in Cardiovascular Medicine, 2023, 10, 1118409

Editorial: Frontiers Media S.A.

 Año de publicación: 2023

Nº de páginas: 13

Tipo de publicación: Artículo de Revista

 DOI: 10.3389/fcvm.2023.1118409

ISSN: 2297-055X

Autores/as

SAINZ LASO, FERMÍN

LEE, DAE-HYUN

RUISÁNCHEZ VILLAR, CRISTINA

PIEDAD IDOIA LERENA SAENZ

GARCÍA CAMARERO, TAMARA

JOSE MARIA CUESTA COSGAYA

BENITO, MERCEDES

BARRERA, SERGIO

BROWN, JONATHAN

ARITZ GIL ONGAY

EDELMAN, ELAZAR R.

GABRIELA VEIGA FERNANDEZ