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Transcatheter Aortic Valve Implantation outcomes in patients with low flow – low gradient aortic stenosis
Session:
Comunicações Orais (Sessão 19) - Prémio Jovem Investigador - Investigação Clínica
Speaker:
Alexandra Castelo
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Alexandra Castelo; André Grazina; Tiago Mendonça; Inês Rodrigues; Pedro Brás; Vera Ferreira; José Viegas; Ruben Ramos; António Fiarresga; Duarte Cacela; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Background</u>: There are limited data about the outcomes of transcatheter aortic valve implantation (TAVI) in patients with low flow – low gradient (LF-LG) aortic stenosis (AS), but some studies suggest that these patients may have worse results.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Purpose</u>: To compare outcomes between LF-LG AS and high gradient AS patients submitted to TAVI.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methods</u>: Retrospective analysis of consecutive patients (P) submitted to TAVI between 2009 and 2020 in a tertiary center. Baseline characteristics and outcomes after the procedure were collected. LF-LG AS was considered in patients with mean gradient <40mmHg, valve area <1mm2, stroke volume index <35mL/m2 and at least one other criteria of contractile reserve confirmed by stress echocardiography, with elevation of mean gradient to >40mmHg, or high aortic calcium score in angio-CT.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Results</u>: A total of 517P (56,3% female) were included, with a mean age of 82 ± 6years. Patients with LF-LG AS (99P, 19,1%) had worse baseline characteristics, with higher STS score (7,4% vs 5,6%, p <0,0001), and natriuretic peptide B (9585 vs 2903 pg/mL, p = 0,001), more frequent left ventricular ejection fraction (LVEF) <40% (27,3% vs 8,8%, p <0,0001), more coronary artery disease (54,5% vs 37,1%, p = 0,002), including previous myocardial infarction (25,3% vs 14,1%, p = 0,008) and coronary artery bypass graft (27,3% vs 12,3%, p<0.0001), more frequent previous valvular surgery (12,1% vs 5,5%, p = 0,02) and more atrial fibrillation (44,4% vs 32,2%, p = 0,022) and pacemaker implantation (13,1% vs 7,1%, p = 0,049). In univariable analysis, LF-LG AS was associated with worse 30-day, 1 year and long-term functional class (NYHA 3-4 - 11,5% vs 2,9%, p = 0,001; 16,5% vs 3,6% p<0,0001 and 18,7% vs 5,8%, p<0,0001, respectively), 1 year mortality (17,2% vs 9,8%, p = 0,045) and 1 year and long-term heart failure hospitalizations (16,3% vs 3%, p<0,0001 and 22,8% vs 6,0%, p<0,0001). When adjusted to the differences in baseline characteristics, in a multivariable analysis, LF-LG AS was still associated with worse functional class at 30 days (p = 0,011), 1 year (p = 0,021) and long-term (p = 0,021) and with heart failure hospitalizations at 1 year and long-term (p = 0,001 for both). In a sub-analysis considering only the patients with LF-LG AS, those with LVEF <40% have the worst outcomes, with more global, intra-hospital and 30 days mortality (48,1% vs 18,1%, p = 0,002; 14,8% vs 1,4%, p = 0,019; 18,5% vs 1,4%, p = 0,005), global and 30 days cardiovascular mortality (25,9% vs 5,6%, p = 0,004 and 18,5% vs 1,4%, p= 0,005), worse 1 year functional class (31,8% vs 11,6%, p = 0,026) and more long-term heart failure hospitalizations (40,9% vs 17,1%, p = 0,002).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Conclusion</u>: Patients with LF-LG AS have worse short and long-term outcomes, even when adjusted for baseline characteristics differences. The sub-group of patients with LVEF <40% have the worst global outcomes.</span></span></p>
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