Universität zu Köln

Wilde, Nihal, Sugiura, Atsushi, Sedaghat, Alexander, Becher, Marc Ulrich, Kelm, Malte, Baldus, Stephan, Nickenig, Georg, Veulemans, Verena and Tiyerili, Vedat . Risk of mortality following transcatheter aortic valve replacement for low-flow low-gradient aortic stenosis. Clin. Res. Cardiol.. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1861-0692

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Abstract

Background Low-flow low-gradient (LF-LG) aortic stenosis (AS) is associated with high mortality, even after transcatheter aortic valve replacement (TAVR). Further knowledge of risk indicators is needed and a clinical risk score would be desirable for optimizing patient selection and therapeutic strategy. Methods The study cohort comprised of 219 consecutive LF-LG AS patients undergoing TAVR from 2008 to 2018 in two high-volume German centers. Predictive factors for one-year all-cause mortality were defined according to a Cox proportional hazard model. Results At one-year follow-up after TAVR, 28% of patients had died. A multivariate model revealed six independent predictors of one-year mortality: history of myocardial infarction (HR 2.05, 95%CI 1.13-3.72), eGFR < 30 ml/min/1.73m(2)(HR 2.75, 95%CI 1.48-5.11), tricuspid regurgitation moderate or more (HR 2.06, 95%CI 1.14-3.72), stroke volume index < 25 mL/m(2)(HR 2.03, 95%CI 1.14-3.62), self-expandable device (HR 2.72, 95%CI 1.17-6.27), and non-transfemoral approach (HR 3.42, 95%CI 1.28-9.14). The Rhineland Risk Score (RRS) consisting of these variables (c statistic 0.75, 95%CI 0.68-0.82,p < 0.001) was superior to the EuroSCORE II (c statistic 0.63) and STS-PROM score (c statistic 0.69) at predicting one-year mortality. Patients with a RRS >= 8 had a prohibitive risk of one-year mortality of 67.6% (95%CI 52.0-82.4%). Conclusion In patients with LF-LG AS, history of myocardial infarction, renal dysfunction, tricuspid regurgitation, a low stroke volume index, self-expandable device, and non-femoral approach were associated with increased 1-year mortality after TAVR. The RRS might serve as a helpful tool for risk prediction and patient selection for TAVR in patients with LF-LG AS.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Wilde, Nihal UNSPECIFIED UNSPECIFIED UNSPECIFIED Sugiura, Atsushi UNSPECIFIED UNSPECIFIED UNSPECIFIED Sedaghat, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Becher, Marc Ulrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Kelm, Malte UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Nickenig, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Veulemans, Verena UNSPECIFIED UNSPECIFIED UNSPECIFIED Tiyerili, Vedat UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-315039
DOI:	10.1007/s00392-020-01752-4
Journal or Publication Title:	Clin. Res. Cardiol.
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1861-0692
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LEFT-VENTRICULAR DYSFUNCTION; TRICUSPID REGURGITATION; EJECTION FRACTION; MULTICENTER; IMPACT; IMPLANTATION; PREDICTORS; OUTCOMES; TOPAS; TAVI Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/31503