Universität zu Köln

Ludwig, Sebastian ORCID: 0000-0002-5752-4951, Gossling, Alina, Seiffert, Moritz, Westermann, Dirk, Sinning, Jan-Malte, Sugiura, Atsushi, Adam, Matti, Mauri, Victor ORCID: 0000-0003-2678-3501, Frank, Derk, Seoudy, Hatim, Rudolph, Tanja, Potratz, Max, Conradi, Lenard and Schofer, Niklas (2022). Risk prediction in patients with low-flow, low-gradient aortic stenosis and reduced ejection fraction undergoing TAVI. Open Heart, 9 (1). LONDON: BMJ PUBLISHING GROUP. ISSN 2053-3624

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Abstract

Objective Patients with low-flow, low-gradient aortic stenosis (LFLG AS) and reduced left ventricular ejection fraction (LVEF) are known to suffer from poor prognosis after transcatheter aortic valve implantation (TAVI). This study aimed to develop a simple score system for risk prediction in this vulnerable subset of patients. Methods All patients with LFLG AS with reduced EF and sufficient CT data for aortic valve calcification (AVC) quantification, who underwent TAVI at five German centres, were retrospectively included. The Risk prEdiction in patients with Low Ejection Fraction low gradient aortic stenosis undergoing TAVI (RELiEF TAVI) score was developed based on multivariable Cox regression for all-cause mortality. Results Among all included patients (n=718), RELiEF TAVI score variables were defined as independent predictors of mortality: male sex (HR 1.34 (1.06, 1.68), p=0.013), underweight (HR 3.10 (1.50, 6.40), p=0.0022), chronic obstructive pulmonary disease (HR 1.55 (1.21, 1.99), p=0.001), pulmonary hypertension (HR 1.51 (1.17, 1.94), p=0.0015), atrial fibrillation (HR 1.28 (1.03, 1.60), p=0.028), stroke volume index (HR 0.96 (0.95, 0.98), p<0.001), non-transfemoral access (HR 1.36 (1.05, 1.76), p=0.021) and low AVC density (HR 1.44 (1.15, 1.79), p=0.0012). A score system was developed ranging from 0 to 12 points (risk of 1-year mortality: 13%-99%). Kaplan-Meier analysis for low (0-1 points), moderate (2-4 points) and high RELiEF TAVI score (>4 points) demonstrated rates of 18.0%, 29.0% and 46.1% (p<0.001) for all-cause mortality and 23.8%, 35.9% and 53.4% (p<0.001) for the combined endpoint of all-cause mortality or heart failure rehospitalisation after 1 year, respectively. Conclusions The RELiEF TAVI score is based on simple clinical, echocardiographic and CT parameters and might serve as a helpful tool for risk prediction in patients with LFLG AS and reduced LVEF scheduled for TAVI.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ludwig, Sebastian UNSPECIFIED orcid.org/0000-0002-5752-4951 UNSPECIFIED Gossling, Alina UNSPECIFIED UNSPECIFIED UNSPECIFIED Seiffert, Moritz UNSPECIFIED UNSPECIFIED UNSPECIFIED Westermann, Dirk UNSPECIFIED UNSPECIFIED UNSPECIFIED Sinning, Jan-Malte UNSPECIFIED UNSPECIFIED UNSPECIFIED Sugiura, Atsushi UNSPECIFIED UNSPECIFIED UNSPECIFIED Adam, Matti UNSPECIFIED UNSPECIFIED UNSPECIFIED Mauri, Victor UNSPECIFIED orcid.org/0000-0003-2678-3501 UNSPECIFIED Frank, Derk UNSPECIFIED UNSPECIFIED UNSPECIFIED Seoudy, Hatim UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Tanja UNSPECIFIED UNSPECIFIED UNSPECIFIED Potratz, Max UNSPECIFIED UNSPECIFIED UNSPECIFIED Conradi, Lenard UNSPECIFIED UNSPECIFIED UNSPECIFIED Schofer, Niklas UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-685349
DOI:	10.1136/openhrt-2021-001912
Journal or Publication Title:	Open Heart
Volume:	9
Number:	1
Date:	2022
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	2053-3624
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language BODY-MASS INDEX; VALVE-REPLACEMENT; PROGNOSTIC IMPACT; MORTALITY; IMPLANTATION; OUTCOMES; STRATIFICATION; CALCIFICATION; REGURGITATION; INSIGHTS Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/68534