Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
Prognostic impact of low-flow conditions in percutaneous treatment of severe aortic stenosis –a matter of flow versus volume
Session:
Posters (Sessão 2 - Écran 4) - Doença valvular
Speaker:
Diogo Santos Ferreira
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.7 Valvular Heart Disease - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Diogo Santos Ferreira; Silvia Diaz; Isabel Fernandes; Cláudio Guerreiro; Mariana Brandão; Rafael Teixeira; Fábio Nunes; Eulália Pereira; Francisco Sampaio; Gustavo Pires-Morais; Bruno Melica; Lino Santos; Alberto Rodrigues; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">BACKGROUND: Low-flow status is a prognostic predictor of mortality after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (SAS). However, the best parameter to truly assess flow is still unknown. Although it has been classically defined using stroke volume index (SVi), transaortic flow rate (FR - stroke volume divided by left ventricle ejection time) has recently been suggested to be superior to SVi, more closely reflecting valvular resistance and being independent of body surface area.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">PURPOSE: Assess the prognostic impact of low-FR (<200mL/s) and low-SVi (<35ml/m2) before TAVI in survival after percutaneous intervention for SAS.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">METHODS: All consecutive TAVI performed in a single-centre between 2011 and 2019 were retrospectively analyzed, and only cases with pre-intervention echocardiograms available were included. Low-flow patients were defined as having a basal FR <200mL/s or SVi <35mL/m2, and compared with normal-flow cases. The primary endpoint was defined as time to all-cause death of last follow-up over five years. The prognostic value of flow (using FR or SVi) was assessed using Kaplan-Meier curves, log-rank test and Cox proportional hazard model adjusted for EuroSCORE II. A secondary analysis divided patients according to preserved and reduced ejection fraction (EF, <52%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">RESULTS: From 657 TAVI performed, 490 (74.6%) cases were included, with a median follow-up of 56 months. From those, 59.6% had low-FR, and 43.3% had low-SVi. Low-flow patients were of higher surgical risk (EuroSCORE II and STS scores), had more advanced New York Heart Association (NYHA) classes, worse estimated creatinine clearance, and suffered more frequently from coronary artery disease. Low-FR patients were also older, and less predominantly male. Atrial fibrillation was more prevalent among low SVi cases. Functional aortic valve area was lower in low-flow patients using both assessments, but low-SVi was also associated with lower transaortic gradients, as well as lower EF before and after TAVI. A low-FR was associated with worse survival [hazard ratio (HR) 1.43 (1.06-1.92), p=0.019], even after adjusting for EuroSCORE II [HR 1.39 (1.03-1.90), p=0.034], contrary to low-SVi (p=0.06 and p=0.2 for uni- and multivariable analysis, respectively). When considering FR and SVi as continuous variables, a higher SVi (but not FR) was associated with improved survival [HR 0.98 (0.97-1.00), p=0.018; HR 0.99 (0.97-1.00), p=0.044 for uni- and multivariable analysis, respectively]. When stratifying according to preserved and reduced EF, both FR and SVi did not predict all-cause mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CONCLUSIONS: Low-flow conditions are common in SAS population subjected to TAVI, being frequently associated with more advanced symptoms and higher procedural risk. Low-FR negatively impacts survival after intervention. SVi is also prognostic as a continuous variable, but not at a <35ml/s cut-off.</span></span></p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site