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Defining a prognostically relevant threshold for stroke volume index in severe aortic stenosis patients undergoing transcatheter valve implantation
Session:
Comunicações Orais - Sessão 28 - Doença Valvular e Endocardite
Speaker:
Diogo Santos Ferreira
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.8 Infective Endocarditis - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Diogo Santos Ferreira; Silvia Diaz; Isabel Fernandes; Cláudio Guerreiro; Mariana Brandão; Fábio Nunes; Rafael Teixeira; Eulália Pereira; Francisco Sampaio; Gustavo Pires-Morais; Bruno Melica; Lino Santos; Alberto Rodrigues; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">BACKGROUND: The most commonly used parameter to define low-flow conditions in patients with severe aortic stenosis (SAS) is a stroke volume index (SVi) below 35mL/m<sup>2</sup>. Low-flow status has been associated with a worse prognosis, including in patients undergoing transcatheter aortic valve implantation (TAVI). However, recent studies have suggested different cut-offs defining a low-SVi associated with worse survival after valvular intervention.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">PURPOSE: Assess the prognostic impact of SVi before TAVI in SAS treatment and determine a relevant threshold in this context.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">METHODS: A single-centre retrospective analysis of all TAVI performed in 2011 and 2019 was conducted. Cases without pre-intervention echocardiograms available were excluded. The primary endpoint was defined as time to all-cause death of last follow-up over the five years after intervention. Surv_cutpoint from survival package in R was used to evaluate optimal low-SVi cutpoints associated with worse survival in SAS patients undergoing TAVI. Low-flow patients were compared with normal-flow counterparts using the determined low-SVi definition. The prognostic value of low-SVi at different cut-offs was assessed using Kaplan-Meier curves and log-rank test, as well as Cox proportional hazard model adjusted for EuroSCORE II. Patients were further divided as having preserved or reduced ejection fraction (EF, <52%). <em>p</em><0.05 was considered statistically significant.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">RESULTS: From 657 TAVI performed, 488 (74%) cases were included, with a median follow-up of 56 months. There was not a statistically significant association between SVi<35mL/m<sup>2</sup> and higher mortality after TAVI (p=0.07). An optimal cutpoint of low-SVi was defined at <29mL/m<sup>2</sup> (n=115, 24%), and these patients were in more advanced New York Heart Association (NYHA) class, had a higher estimated surgical risk, had a higher prevalence of hypertension, anemia and atrial fibrillation. Low-SVi patients also had lower EF, lower functional aortic valve area and lower transvalvular gradients, and were more frequently treated with balloon-expandable valves. SVi<29mL/m<sup>2</sup> was associated with worse survival after intervention, including after adjusting to EuroSCORE II [hazard ratio (HR) 1.60 (1.18-2.17), p=0.003] , and in a reduced [HR 1.58 (1.04-2.41), p=0.031], but not preserved, EF subset. When analyzed as a continuous variable, a higher SVi was associated with better survival after TAVI [HR 0.98 (0.97-1.00), p=0.019].</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CONCLUSIONS: SVi is a prognostically-relevant measure in SAS patients undergoing TAVI. Contrary to a classically defined threshold of <35mL/m<sup>2</sup>, a SVi<29mL/m<sup>2</sup> was associated with higher mortality after treatment in our population.</span></span></p>
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