Incremental value of left ventricular capacitance in predicting outcome in patients undergoing to percutaneous aortic valve implantation
Purpose: To evaluate the incremental value of Left Ventricular Capacitance in predicting outcome of patients undergoing to Percutaneous Aortic Valve Implantation (TAVI) using a partial non-invasive approach. Methods: We retrospectively evaluated 160 patients (Age 82±5 years; Female 60%) with severe symptomatic aortic valve stenosis (AVAi<0,6 cmq/m2) and preserved left ventricular function (EF>50%) at high surgical risk (Log Euroscore 17,1±8,7%) who performed TAVI procedure with Corevalve Prosthesis. Single beat method for estimation of left ventricular end diastolic pressure volume relationship (EDPVR) was used to characterize diastolic properties of LV, on the basis of the premise that volume normalized EDPVRs share a common shape (LVEDP= α x EDVβ). LVEDP was estimated invasively, before TAVI. LVEDV was evaluated non invasively by 2D echocardiography. Derived α and β indices were used to predict EDV at LVEDP 20 mmHg (EDV20). Qualitative angiographic method to grade paravalvular leak (PVL) was used according to the VARC-2 criteria. The primary end point of the study was one year death from any causes. Secondary end-point was one year death from cardiovascular causes after TAVI. Results: After TAVI, a prosthetic regurgitation (PVL) was observed in 128 patients (80%). Moderate regurgitation was observed in 30 patients (18,7%) and severe in 4 patients (2,5%). During 1 year follow-up the primary end point (all cause mortality) was reached in 19 patients (11.8%). The secondary end point (cardiovascular mortality) occurred in 13 patients (8.1%). On Univariate Cox regression analysis several parameters were significantly associated to all cause mortality but on multivariate analysis we identified only moderate/severe PVL (HR 5, CI 2,1 to 12,5, p=0,0004), NYHA functional class (HR 2,5, CI 1,2 to 5,5, p=0,015) and EDV20 (HR 0,95, CI 0,94 to 0,99, p=0,009) as independent risk factors for all cause mortality. EDV20 and moderate/severe PVL were also associated with Cardiovascular Mortality (Multiple Cox regression: PVL HR 5,6 IC 95% 2 to 16; p=0,0015; EDV20 HR 0,96 IC95% 0,93 to 0,99; p=0,02). Conclusions: Paravalvular aortic regurgitation (PVL) after TAVI adversely affects outcome of patients. Diastolic left ventricular properties play a pivotal role in determining the response of left ventricle to the changes in haemodynamic conditions. A severely reduced left ventricular compliance is a strong independent predictor of adverse events. Partial non invasive estimation of left ventricular diastolic properties is an useful tool in predicting the outcome and in risk stratification after TAVI.
Incremental value of left ventricular capacitance in predicting outcome in patients undergoing to percutaneous aortic valve implantation
CONTE, LORENZO;FABIANI, IACOPO;DE CARO, FRANCESCO;De Carlo, M.;BARLETTA, VALENTINA;PETRONIO, ANNA;DI BELLO, VITANTONIO
2014-01-01
Abstract
Purpose: To evaluate the incremental value of Left Ventricular Capacitance in predicting outcome of patients undergoing to Percutaneous Aortic Valve Implantation (TAVI) using a partial non-invasive approach. Methods: We retrospectively evaluated 160 patients (Age 82±5 years; Female 60%) with severe symptomatic aortic valve stenosis (AVAi<0,6 cmq/m2) and preserved left ventricular function (EF>50%) at high surgical risk (Log Euroscore 17,1±8,7%) who performed TAVI procedure with Corevalve Prosthesis. Single beat method for estimation of left ventricular end diastolic pressure volume relationship (EDPVR) was used to characterize diastolic properties of LV, on the basis of the premise that volume normalized EDPVRs share a common shape (LVEDP= α x EDVβ). LVEDP was estimated invasively, before TAVI. LVEDV was evaluated non invasively by 2D echocardiography. Derived α and β indices were used to predict EDV at LVEDP 20 mmHg (EDV20). Qualitative angiographic method to grade paravalvular leak (PVL) was used according to the VARC-2 criteria. The primary end point of the study was one year death from any causes. Secondary end-point was one year death from cardiovascular causes after TAVI. Results: After TAVI, a prosthetic regurgitation (PVL) was observed in 128 patients (80%). Moderate regurgitation was observed in 30 patients (18,7%) and severe in 4 patients (2,5%). During 1 year follow-up the primary end point (all cause mortality) was reached in 19 patients (11.8%). The secondary end point (cardiovascular mortality) occurred in 13 patients (8.1%). On Univariate Cox regression analysis several parameters were significantly associated to all cause mortality but on multivariate analysis we identified only moderate/severe PVL (HR 5, CI 2,1 to 12,5, p=0,0004), NYHA functional class (HR 2,5, CI 1,2 to 5,5, p=0,015) and EDV20 (HR 0,95, CI 0,94 to 0,99, p=0,009) as independent risk factors for all cause mortality. EDV20 and moderate/severe PVL were also associated with Cardiovascular Mortality (Multiple Cox regression: PVL HR 5,6 IC 95% 2 to 16; p=0,0015; EDV20 HR 0,96 IC95% 0,93 to 0,99; p=0,02). Conclusions: Paravalvular aortic regurgitation (PVL) after TAVI adversely affects outcome of patients. Diastolic left ventricular properties play a pivotal role in determining the response of left ventricle to the changes in haemodynamic conditions. A severely reduced left ventricular compliance is a strong independent predictor of adverse events. Partial non invasive estimation of left ventricular diastolic properties is an useful tool in predicting the outcome and in risk stratification after TAVI.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
