AUTHOR=Kjønås Didrik , Schirmer Henrik , Aakhus Svend , Eidet Jo , Malm Siri , Aaberge Lars , Busund Rolf , Rösner Assami 

TITLE=Clinical and Echocardiographic Parameters Predicting 1- and 2-Year Mortality After Transcatheter Aortic Valve Implantation

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.739710

DOI=10.3389/fcvm.2021.739710

ISSN=2297-055X

ABSTRACT=Background: Transcatheter aortic valve implantation (TAVI) has become a standard treatment option for patients with symptomatic aortic stenosis. Elderly high-risk patients with aortic stenosis treated with transcatheter aortic valve implantation (TAVI) have a high residual mortality due to pre-existing comorbidities. Knowledge of factors predicting futility after TAVI is sparse and clinical tools to aid the preoperative evaluation are lacking. The aim of this study was to evaluate if echocardiographic measures, including speckle-tracking analysis, in addition to clinical parameters could aid in the prediction of mortality beyond 30-days after TAVI. 

Methods: This prospective observational cohort study included 227 patients treated with TAVI at the University Hospital of North Norway and Oslo University Hospital Rikshospitalet from February 2010 through June 2013. All patients underwent preoperative echocardiographic evaluation with retrospective speckle-tracking analysis. Primary endpoints were 1-and 2-year mortality beyond 30-days after TAVI. 

Results: All cause 1-and-2-year mortality beyond 30-days after TAVI was 12,1% and 19,5% respectively. Predictors of 1-year mortality beyond 30-days were body mass index (HR: 0.88, 95% CI 0.80-0.98, P=0.018), previous myocardial infarction (HR; 2.69, 95% CI 1.14-6.32, P=0.023), and systolic pulmonary arterial pressure ≥60 mmHg (HR: 5.93, 95% CI 1.67-21.1, P=0.006). Moderate to severe mitral regurgitation (HR: 2.93, 95% CI 1.53-5.63, P=0.001), estimated glomerular filtration rate (HR: 0.98, 95% CI 0.96-0.99, P=0.002) and chronic obstructive pulmonary disease (HR: 1.9, 95% CI 1.01-3.58, P=0.046) were predictors of 2-year mortality.

Conclusion: Both clinical and echocardiographic parameters should be considered when evaluating high-risk patients for TAVI, as both are predictive of 1-and-2 year mortality. Our results support the importance of individual risk assessment using a multidisciplinary, multimodal, and individual approach.