AUTHOR=de la Torre Hernandez Jose M. , Veiga Fernandez Gabriela , Ben-Assa Eyal , Sainz Laso Fermin , Lee Dae-Hyun , Ruisanchez Villar Cristina , Lerena Piedad , Garcia Camarero Tamara , Cuesta Cosgaya Jose M. , Fradejas-Sastre Victor , Benito Mercedes , Barrera Sergio , Garcia-Unzueta Maria T. , Brown Jonathan , Gil Ongay Aritz , Zueco Javier , Vazquez de Prada Jose A. , Edelman Elazer R. 

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1118409

DOI=10.3389/fcvm.2023.1118409

ISSN=2297-055X

ABSTRACT=BACKGROUND 
A non-negligible proportion of patients who undergo transcatheter aortic valve replacement (TAVR) do not report any symptomatic improvement or even die in the short-mid term. We sought to assess the degree of objective functional recovery after TAVR, 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 procedure. These parameters were derived from echocardiography, non-invasive analysis of arterial pulse wave and cardiac tomography. Objective functional improvement 6 months after TAVR was assessed using 6-minute walk test and NT-proBNP levels. The derived predictive model was prospectively validated in a different cohort. 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 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 mean aortic gradient ≥40 mmHg, augmentation index75 ≥45%, posterior wall thickness ≤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.
CONCLUSIONS
A 80% of patients experienced objective functional improvement after TAVR, showing a significantly lower 2-year mortality rate. A predictive score was built which showed a good discriminative performance in overall and low-gradient populations.