SPC365

Flow rate in severe aortic stenosis – a good prognostic marker for percutaneous valve implantation?

Session: Posters (Sessão 2 - Écran 8) - Doença Valvular 2 - Foco no Ecocardiograma na Válvula Aórtica
Speaker: Isabel Nóbrega Fernandes

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: Pósters Electrónicos
FP Number: ---
Authors: Isabel Fernandes; Diogo Santos Ferreira; Silvia Diaz; Cláudio Guerreiro; Mariana Brandão; Mariana Ribeiro Silva; Gualter Silva; Pedro Ribeiro Queirós; Eulália Pereira; Gustavo Pires de Morais; Bruno Melica; Lino Santos; Alberto Rodrigues; Pedro Braga; Ricardo Fontes-Carvalho

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">BACKGROUND: </span></span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">The true severity assessment of aortic stenosis (AS) is not infrequently challenging, especially when it is paradoxical in its nature and low-flow states originate low-gradient evaluations. Several markers have been suggested to identify potential causes for discordant values between aortic valve area and mean pressure gradients, including stroke volume index and transaortic flow rate (FR). The latter has been recently proposed as a new prognostic marker for mortality, being low FR associated with worse outcomes, including after aortic valve intervention.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">METHODS: </span></span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">A single-centre retrospective database of all consecutive Transcatheter Aortic Valve Implantation (TAVI) procedures performed between June 2011 and December 2019 was analyzed. The primary outcome was defined as time to death or last follow-up after the intervention, through Kaplan-Meier survival analysis. Other outcomes were assessed, namely patients&rsquo; clinical, echocardiographic and analytical characteristics at baseline and during follow-up and its association between FR state, using Pearson&rsquo;s Chi-squared test, Wilcoxon rank sum test and Fisher&rsquo;s exact test, as appropriate. A low FR state was defined as </span></span>&le;<span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">200ml/s in the primary analysis. A p&lt;0.05 was considered statistically significant.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">RESULTS: </span></span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">A total of 295 cases had complete echocardiographic data available and were considered in this study (image 1). There was a higher predominance of female gender among low-FR patients (61% versus 41%, p=0.001), who were older (82- versus 80-years-old, p=0.019), and had a lower body mass index (26.4 versus 27.7 kg/m<sup>2</sup>, p=0.007). A low FR state was associated with a statistically significant higher surgical risk estimated through EuroSCORE II, STS mortality and morbimortality. Estimated creatinine clearance was also lower in this subset (45 versus 53ml/m<sup>2</sup> using Cockcroft-Gault Formula, p=0.001), as well as aortic valve area (0.60 versus 0.75cm<sup>2</sup>, p&lt;0.001). However, Kaplan-Meier curves over 5-years did not confirm a statistically significant difference in prognosis after TAVI (p=0.37). Multiple secondary analysis, using different cut-offs for low-FR state (200-250ml/ms) also confirmed the same conclusions.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">CONCLUSIONS: </span></span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"><span style="color:black">Despite exhibiting pre-intervention characteristics generally associated with worse prognosis after valvular treatment, a low-FR state was not associated with inferior survival outcomes with TAVI in the present analysis. However, these represent exploratory deductions from cases performed in a single-centre.</span></span></span></span></p>