SPC365

CAPL-score: Anticipating Futility in Transcatheter Aortic Valve Implantation (TAVI)

Session: Comunicações Orais - Sessão 17 - Miscelânea
Speaker: Mariana Martinho

Congress: CPC 2024
Topic: P. Other
Theme: 37. Miscellanea
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Mariana Martinho; Rita Calé; Ana Marques; Pedro Santos; Ana Rita Pereira; Bárbara Marques Ferreira; Diogo Santos Cunha; Cristina Martins; Inês Cruz; Paula Fazendas; Isabel João; Hélder Pereira
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">Introduction</span></span></span></span></strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">: Futility in Transcatheter Aortic Valve Implantation (TAVI), acknowledged by the latest guidelines as an expected survival of less than 1year, results in an unnecessary exposure of risk for patients (pts) and an inefficient use of healthcare resources. Considering that advanced age alone does not preclude pt referral, alternative parameters and scores (such as Charlson comorbidity index and Euroscore-II) have been proposed to predict futility of the procedure for aortic stenosis (AS) treatment. However, current practice still relies on subjective referral. </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">Objectives</span></span></span></span></strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">: To identify independent predictors of 1-year mortality in a Portuguese population undergoing TAVI implantation and the development of a risk stratification scoring system, comparing it to other existing models. </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">Methods</span></span></span></span></strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">: Retrospective single center study including consecutive pts accepted for TAVI, between 2015 and 2022. Clinical, echocardiographic and follow-up data were evaluated. Independent predictors for 1</span></span></span></span><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">y-mortality were identified using Cox regression analysis, and since adjustment had little effect on the coefficient, the proposed score was developed from using the unadjusted Cox proportional hazards model. The Charlson </span></span></span></span><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">comorbidity index (CCI) and the Euroscore-II were applied to each case. Receiver operating characteristic (ROC) curves and area under curve (AUC) were calculated for these scores and used for comparison.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">Results</span></span></span></span></strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">: A total of 75pts were included (mean age 82&plusmn;6y; 56.0% females). Classical AS was predominant (90.7%), followed by 6.7% low-flow-low-gradient (LFLG) AS, and 2.7% paradoxical LFLG AS. One-year mortality rate was 17.3% (n=13). Although neither age, nor CCI were predictors of 1y-mortality, when the CCI resulting from subtracting the points assigned to age was &gt;5points, it was an independent predictor of the outcome (4.43, 95%CI 0.96-20.51, p=0.057). After multivariate analysis, other predictors of 1y-mortality were pulmonary hypertension given by an estimated pulmonary systolic artery pressure (PSAP) </span></span></span></span><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Symbol"><span style="color:#3b3838">&sup3;</span></span></span></span><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">35mmHg (HR 4.63, 95%CI 0.77-27.80, p=0.094), and left ventricle dilation with an indexed LV end-diastolic volume </span></span></span></span><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Symbol"><span style="color:#3b3838">&sup3;</span></span></span></span><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">75mL/m<sup>2</sup> (HR 5.51, 95%CI 1.01-30.01, p=0.048). For the 50pts that had all CAPL-score parameters available, AUC was 0.806 (95%CI 0.671-0.942, p=.003), which performed better than the previously proposed scores, such as Euroscore-II. In this population, a CAPL-score of 0 points, 3-5 points, 6-8 points, and &gt; 9 points predicted a 1y-mortality of 0%, 26.3%, 37.5% and 100% respectively.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">Conclusions</span></span></span></span></strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:Helvetica"><span style="color:#3b3838">: In this population, there was a significant rate of 1y-mortality that was independent of advanced age. Upon comparison with alternative scoring systems, the suggested model exhibited superior accuracy in stratifying pt risk, indicating it as a potential tool to prevent futility. Nevertheless, validation with a larger population is necessary. </span></span></span></span></span></span></p>