Long-term survival after TAVI in low-flow, low-gradient aortic valve stenosis

被引：1
作者：
Cardaioli, Francesco [1 ]
Fovino, Luca Nai [1 ]
Fabris, Tommaso [1 ]
Masiero, Giulia [1 ]
Arturi, Federico [1 ]
Panza, Andrea [1 ]
Bertolini, Andrea [1 ]
Rodino, Giulio [1 ]
Continisio, Saverio [1 ]
Napodano, Massimo [1 ]
Lorenzoni, Giulia [1 ]
Gregori, Dario [2 ]
Fraccaro, Chiara [1 ]
Tarantini, Giuseppe [1 ]
机构：
[1] Univ Padua, Med Sch, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Padua, Italy
[2] Univ Padua, Unit Biostat Epidemiol & Publ Hlth, Padua, Italy
来源：
EUROINTERVENTION | 2024年 / 20卷 / 22期
关键词：
aortic stenosis; depressed left ventricular function; TAVI; PARADOXICAL LOW-FLOW; ESC/EACTS GUIDELINES; RISK PATIENTS; PREDICTORS; OUTCOMES; IMPLANTATION; REPLACEMENT; MULTICENTER; MANAGEMENT; IMPACT;
D O I：
10.4244/EIJ-D-24-00442
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
BACKGROUND: In patients undergoing transcatheter aortic valve implantation (TAVI), the presence of a low-flow, low-gradient (LFLG) status has been associated with higher mortality at short-term follow-up. AIMS: We aimed to evaluate long-term survival after TAVI in patients with classical (cLFLG) and paradoxical LFLG (pLFLG) aortic stenosis (AS) compared to high-gradient (HG)-AS. METHODS: Patients undergoing TAVI at our centre with a hypothetical minimum 5-year follow-up were divided into 3 groups: (1) HG-AS (mean gradient [MG] >40 mmHg), (2) cLFLG-AS (MG <40 mmHg, ejection fraction [EF] <50%), and (3) pLFLG-AS (MG <40 mmHg, EF >= 50%). The primary endpoint of the study was all-cause mortality. Propensity score-weighted survival analysis was performed to adjust for possible baseline confounders. RESULTS: A total of 574 subjects were included (73% HG-AS, 15% pLFLG-AS, 11% cLFLG-AS). The median survival time was 4.8 years, with a maximum of 12.3 years. Patients with cLFLG-AS presented the highest baseline cardiovascular risk. At unadjusted survival analysis, patients with cLFLG-AS showed the worst long-term prognosis, with a rapid decrease in survival within the first year, while pLFLG- and HG-AS patients presented similar survival rates (p=0.023). At weighted long-term analysis, cLFLG- and HG-AS had similar survival rates. Baseline EF was not related to long-term mortality, while patients with a post-TAVI left ventricular ejection fraction (LVEF) improvement >10% lived significantly longer (p=0.02). CONCLUSIONS: Classical LFLG-AS patients had lower long-term survival rates as compared to pLFLG-AS and HG-AS patients. However, after adjustment for possible baseline confounders, a low-flow status per se did not have an impact on long-term mortality after TAVI. Post-TAVI LVEF recovery was associated with improved long-term outcome.
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收藏
页码：1380 / 1389
页数：16
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