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Published in: The International Journal of Cardiovascular Imaging 2/2024

Open Access 19-11-2023 | Transcatheter Aortic Valve Implantation | Original Paper

Prognostic value of flow-status in severe aortic stenosis patients undergoing percutaneous intervention

Authors: Diogo Santos-Ferreira, Isabel Fernandes, Sílvia O. Diaz, Cláudio Guerreiro, Francisca Saraiva, António S. Barros, Adelino Leite-Moreira, Eulália Pereira, Francisco Sampaio, José Ribeiro, Pedro Braga, Ricardo Fontes-Carvalho

Published in: The International Journal of Cardiovascular Imaging | Issue 2/2024

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Abstract

Purpose

Low-flow status is a mortality predictor in severe aortic stenosis (SAS) patients, including after transcatheter aortic valve implantation (TAVI) treatment. However, the best parameter to assess flow is unknown. Recent studies suggest that transaortic flow rate (FR) is superior to currently used stroke volume index (SVi) in defining low-flow states. Therefore, we aimed to evaluate the prognostic value of FR and SVi in patients undergoing TAVI.

Methods

A single-centre retrospective analysis of all consecutive patients treated with TAVI for SAS between 2011 and 2019 was conducted. Low-FR was defined as < 200 mL/s and low-SVi as < 35 mL/m2. Primary endpoint was all-cause five-year mortality, analyzed using Kaplan-Meier curves and Cox regression models. Secondary endpoint was variation of NYHA functional class six months after procedure. Patients were further stratified according to ejection fraction (EF < 50%).

Results

Of 489 cases, 59.5% were low-FR, and 43.1% low-SVi. Low-flow patients had superior surgical risk, worse renal function, and had a higher prevalence of coronary artery disease. Low-FR was associated with mortality (hazard ratio 1.36, p = 0.041), but not after adjustment to EuroSCORE II. Normal-SVi was not associated with survival, despite a significative p-trend for its continuous value. No associations were found for flow-status and NYHA recovery. When stratifying according to preserved and reduced EF, both FR and SVi did not predict all-cause mortality.

Conclusion

In patients with SAS undergoing TAVI, a low-FR state was associated with higher mortality, as well as SVi, but not at a 35 mL/m2 cut off.
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Literature
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Metadata
Title
Prognostic value of flow-status in severe aortic stenosis patients undergoing percutaneous intervention
Authors
Diogo Santos-Ferreira
Isabel Fernandes
Sílvia O. Diaz
Cláudio Guerreiro
Francisca Saraiva
António S. Barros
Adelino Leite-Moreira
Eulália Pereira
Francisco Sampaio
José Ribeiro
Pedro Braga
Ricardo Fontes-Carvalho
Publication date
19-11-2023
Publisher
Springer Netherlands
Published in
The International Journal of Cardiovascular Imaging / Issue 2/2024
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-023-02992-x

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