Ulrich Fischer-Rasokat1, Matthias Renker2, Christoph Liebetrau3, Arnaud van Linden4, Mani Arsalan4, Maren Weferling5, Andreas Rolf3, Mirko Doss6, Helge Möllmann7, Thomas Walther8, Christian W Hamm3, Won-Keun Kim9. 1. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Medical Clinic I (Cardiology and Angiology), University Hospital of Giessen, Giessen, Germany. Electronic address: u.fischer-rasokat@kerckhoff-klinik.de. 2. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; German Centre for Cardiovascular Research, Partner Site Rhein-Main, Bad Nauheim, Germany. 3. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Medical Clinic I (Cardiology and Angiology), University Hospital of Giessen, Giessen, Germany; German Centre for Cardiovascular Research, Partner Site Rhein-Main, Bad Nauheim, Germany. 4. Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiac, Thoracic and Thoracic Vascular Surgery, University Hospital of the Goethe University, Frankfurt am Main, Germany. 5. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany. 6. Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany. 7. Department of Cardiology, Medical Clinic I, St. Johann Hospital, Dortmund, Germany. 8. Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; German Centre for Cardiovascular Research, Partner Site Rhein-Main, Bad Nauheim, Germany; Department of Cardiac, Thoracic and Thoracic Vascular Surgery, University Hospital of the Goethe University, Frankfurt am Main, Germany. 9. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; Medical Clinic I (Cardiology and Angiology), University Hospital of Giessen, Giessen, Germany; Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.
Abstract
OBJECTIVES: This study sought to examine whether the prognosis of patients with severe aortic stenosis (AS) having high versus low transvalvular mean pressure gradients (MPGs) is intrinsically different after transcatheter aortic valve replacement (TAVR), even after strict matching of baseline parameters. BACKGROUND: Patients with low MPG are characterized by higher cardiovascular risk and more comorbidities than other AS patients are. METHODS: In this retrospective, single-center study involving 2,282 patients, 3 groups were derived according to the following criteria: 1) high-gradient AS (HG-AS) (MPG ≥40 mm Hg); 2) low-flow, low-gradient AS (LFLG-AS) (MPG <40 mm Hg, ejection fraction [EF] ≤40%, stroke volume index ≤35 ml/m2); 3) paradoxical LFLG-AS (pLFLG-AS) (similar to LFLG-AS but with EF ≥50%). Propensity score matching that included EF was used to compare 1-year survival. RESULTS: A total of 136 patients with HG-AS or LFLG-AS were identified. Kaplan-Meier survival curves were significantly different (p = 0.039), with death occurring in 11 versus 21 patients (hazard ratio: 2.12; 95% confidence interval: 1.02 to 4.39; p = 0.044), respectively. A total of 226 patients with HG-AS or pLFLG-AS were identified and here the curves were identical (p = 0.468), with death occurring in 18 versus 21 patients (hazard ratio: 1.26; 95% confidence interval: 0.67 to 2.38; p = 0.469). CONCLUSIONS: This is the first study comparing survival after TAVR of patients with high versus low MPG in matched study populations. Mortality in patients with LFLG-AS was twice that of HG-AS patients. However, it appears that patients with pLFLG-AS might benefit from TAVR to the same extent as patients with HG-AS. There must be still unmasked factors that influence mortality of patients with LFLG-AS.
OBJECTIVES: This study sought to examine whether the prognosis of patients with severe aortic stenosis (AS) having high versus low transvalvular mean pressure gradients (MPGs) is intrinsically different after transcatheter aortic valve replacement (TAVR), even after strict matching of baseline parameters. BACKGROUND:Patients with low MPG are characterized by higher cardiovascular risk and more comorbidities than other AS patients are. METHODS: In this retrospective, single-center study involving 2,282 patients, 3 groups were derived according to the following criteria: 1) high-gradient AS (HG-AS) (MPG ≥40 mm Hg); 2) low-flow, low-gradient AS (LFLG-AS) (MPG <40 mm Hg, ejection fraction [EF] ≤40%, stroke volume index ≤35 ml/m2); 3) paradoxical LFLG-AS (pLFLG-AS) (similar to LFLG-AS but with EF ≥50%). Propensity score matching that included EF was used to compare 1-year survival. RESULTS: A total of 136 patients with HG-AS or LFLG-AS were identified. Kaplan-Meier survival curves were significantly different (p = 0.039), with death occurring in 11 versus 21 patients (hazard ratio: 2.12; 95% confidence interval: 1.02 to 4.39; p = 0.044), respectively. A total of 226 patients with HG-AS or pLFLG-AS were identified and here the curves were identical (p = 0.468), with death occurring in 18 versus 21 patients (hazard ratio: 1.26; 95% confidence interval: 0.67 to 2.38; p = 0.469). CONCLUSIONS: This is the first study comparing survival after TAVR of patients with high versus low MPG in matched study populations. Mortality in patients with LFLG-AS was twice that of HG-AS patients. However, it appears that patients with pLFLG-AS might benefit from TAVR to the same extent as patients with HG-AS. There must be still unmasked factors that influence mortality of patients with LFLG-AS.
Authors: Ulrich Fischer-Rasokat; Matthias Renker; Christoph Liebetrau; Maren Weferling; Andreas Rieth; Andreas Rolf; Yeong-Hoon Choi; Christian W Hamm; Won-Keun Kim Journal: Cardiovasc Diagn Ther Date: 2021-10
Authors: Julius Steffen; Nikolas Reißig; David Andreae; Markus Beckmann; Magda Haum; Julius Fischer; Hans Theiss; Daniel Braun; Martin Orban; Konstantinos Rizas; Sebastian Sadoni; Michael Näbauer; Sven Peterss; Jörg Hausleiter; Steffen Massberg; Simon Deseive Journal: Clin Res Cardiol Date: 2022-03-23 Impact factor: 5.460