Transcatheter aortic valve implantation in low ejection fraction/low transvalvular gradient patients: the rule of 40

Federico Conrotto, Fabrizio D’Ascenzo, Pieter Stella, Marco Pavani, Marco Luciano Rossi, Nedy Brambilla, Massimo Napodano, Elisa Covolo, Francesco Saia, Giuseppe Tarantini, Pierfrancesco Agostoni, Antonio Marzocchi, Patrizia Presbitero, Francesco Bedogni, Stefano Salizzoni, Maurizio D’Amico, Claudio Moretti, Mauro Rinaldi, Fiorenzo Gaita

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: Several factors have been identified as predictors of events after transcatheter aortic valve implantation (TAVI) but the impact of left ventricular ejection fraction (LVEF) and mean transaortic gradient (MTG) is controversial. This multicenter study aimed to clarify the prognostic role of low LVEF and low MTG after TAVI. METHODS: From 2007 to 2012, 764 consecutive patients with severe symptomatic aortic valve stenosis underwent TAVI at participating hospitals. Patients were divided according to LVEF and MTG into four groups. RESULTS: Sixty-four patients had LVEF 40% or less and MTG less than 40?mmHg, 76 had LVEF 40% or less and MTG at least 40?mmHg, 163 had LVEF more than 40% and MTG less than 40?mmHg, 461 had LVEF more than 40% and MTG at least 40?mmHg. Two-year mortality was significantly higher in patients with low LVEF and low MTG, whereas it was similar in patients with low LVEF and high MTG, high LVEF and low MTG, and high LVEF and high MTG (51.3 vs. 22.4 vs. 23.3. vs. 25.5%, respectively; P?=?0.001). These results were confirmed by multivariate analysis, as the combination of low LVEF and low MTG (both less than 40) was identified as the stronger mid-term mortality predictor (hazard ratio 2.4, confidence interval 95% 1.4–3.9; P?=?0.001). CONCLUSION: At least one parameter between LVEF or MTG over 40 predicts a good prognosis for TAVI patients at mid-term follow-up, whereas those with both left ventricular dysfunction and low mean aortic pressure gradient are at high risk of all-cause death after TAVI.

Original languageEnglish
JournalJournal of Cardiovascular Medicine
DOIs
Publication statusAccepted/In press - May 10 2016

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Stroke Volume
Transcatheter Aortic Valve Replacement
Mortality
Aortic Valve Stenosis
Left Ventricular Dysfunction
Multicenter Studies
Cause of Death
Arterial Pressure
Multivariate Analysis
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Transcatheter aortic valve implantation in low ejection fraction/low transvalvular gradient patients : the rule of 40. / Conrotto, Federico; D’Ascenzo, Fabrizio; Stella, Pieter; Pavani, Marco; Rossi, Marco Luciano; Brambilla, Nedy; Napodano, Massimo; Covolo, Elisa; Saia, Francesco; Tarantini, Giuseppe; Agostoni, Pierfrancesco; Marzocchi, Antonio; Presbitero, Patrizia; Bedogni, Francesco; Salizzoni, Stefano; D’Amico, Maurizio; Moretti, Claudio; Rinaldi, Mauro; Gaita, Fiorenzo.

In: Journal of Cardiovascular Medicine, 10.05.2016.

Research output: Contribution to journalArticle

Conrotto, F, D’Ascenzo, F, Stella, P, Pavani, M, Rossi, ML, Brambilla, N, Napodano, M, Covolo, E, Saia, F, Tarantini, G, Agostoni, P, Marzocchi, A, Presbitero, P, Bedogni, F, Salizzoni, S, D’Amico, M, Moretti, C, Rinaldi, M & Gaita, F 2016, 'Transcatheter aortic valve implantation in low ejection fraction/low transvalvular gradient patients: the rule of 40', Journal of Cardiovascular Medicine. https://doi.org/10.2459/JCM.0000000000000402
Conrotto, Federico ; D’Ascenzo, Fabrizio ; Stella, Pieter ; Pavani, Marco ; Rossi, Marco Luciano ; Brambilla, Nedy ; Napodano, Massimo ; Covolo, Elisa ; Saia, Francesco ; Tarantini, Giuseppe ; Agostoni, Pierfrancesco ; Marzocchi, Antonio ; Presbitero, Patrizia ; Bedogni, Francesco ; Salizzoni, Stefano ; D’Amico, Maurizio ; Moretti, Claudio ; Rinaldi, Mauro ; Gaita, Fiorenzo. / Transcatheter aortic valve implantation in low ejection fraction/low transvalvular gradient patients : the rule of 40. In: Journal of Cardiovascular Medicine. 2016.
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abstract = "BACKGROUND: Several factors have been identified as predictors of events after transcatheter aortic valve implantation (TAVI) but the impact of left ventricular ejection fraction (LVEF) and mean transaortic gradient (MTG) is controversial. This multicenter study aimed to clarify the prognostic role of low LVEF and low MTG after TAVI. METHODS: From 2007 to 2012, 764 consecutive patients with severe symptomatic aortic valve stenosis underwent TAVI at participating hospitals. Patients were divided according to LVEF and MTG into four groups. RESULTS: Sixty-four patients had LVEF 40{\%} or less and MTG less than 40?mmHg, 76 had LVEF 40{\%} or less and MTG at least 40?mmHg, 163 had LVEF more than 40{\%} and MTG less than 40?mmHg, 461 had LVEF more than 40{\%} and MTG at least 40?mmHg. Two-year mortality was significantly higher in patients with low LVEF and low MTG, whereas it was similar in patients with low LVEF and high MTG, high LVEF and low MTG, and high LVEF and high MTG (51.3 vs. 22.4 vs. 23.3. vs. 25.5{\%}, respectively; P?=?0.001). These results were confirmed by multivariate analysis, as the combination of low LVEF and low MTG (both less than 40) was identified as the stronger mid-term mortality predictor (hazard ratio 2.4, confidence interval 95{\%} 1.4–3.9; P?=?0.001). CONCLUSION: At least one parameter between LVEF or MTG over 40 predicts a good prognosis for TAVI patients at mid-term follow-up, whereas those with both left ventricular dysfunction and low mean aortic pressure gradient are at high risk of all-cause death after TAVI.",
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T2 - the rule of 40

AU - Conrotto, Federico

AU - D’Ascenzo, Fabrizio

AU - Stella, Pieter

AU - Pavani, Marco

AU - Rossi, Marco Luciano

AU - Brambilla, Nedy

AU - Napodano, Massimo

AU - Covolo, Elisa

AU - Saia, Francesco

AU - Tarantini, Giuseppe

AU - Agostoni, Pierfrancesco

AU - Marzocchi, Antonio

AU - Presbitero, Patrizia

AU - Bedogni, Francesco

AU - Salizzoni, Stefano

AU - D’Amico, Maurizio

AU - Moretti, Claudio

AU - Rinaldi, Mauro

AU - Gaita, Fiorenzo

PY - 2016/5/10

Y1 - 2016/5/10

N2 - BACKGROUND: Several factors have been identified as predictors of events after transcatheter aortic valve implantation (TAVI) but the impact of left ventricular ejection fraction (LVEF) and mean transaortic gradient (MTG) is controversial. This multicenter study aimed to clarify the prognostic role of low LVEF and low MTG after TAVI. METHODS: From 2007 to 2012, 764 consecutive patients with severe symptomatic aortic valve stenosis underwent TAVI at participating hospitals. Patients were divided according to LVEF and MTG into four groups. RESULTS: Sixty-four patients had LVEF 40% or less and MTG less than 40?mmHg, 76 had LVEF 40% or less and MTG at least 40?mmHg, 163 had LVEF more than 40% and MTG less than 40?mmHg, 461 had LVEF more than 40% and MTG at least 40?mmHg. Two-year mortality was significantly higher in patients with low LVEF and low MTG, whereas it was similar in patients with low LVEF and high MTG, high LVEF and low MTG, and high LVEF and high MTG (51.3 vs. 22.4 vs. 23.3. vs. 25.5%, respectively; P?=?0.001). These results were confirmed by multivariate analysis, as the combination of low LVEF and low MTG (both less than 40) was identified as the stronger mid-term mortality predictor (hazard ratio 2.4, confidence interval 95% 1.4–3.9; P?=?0.001). CONCLUSION: At least one parameter between LVEF or MTG over 40 predicts a good prognosis for TAVI patients at mid-term follow-up, whereas those with both left ventricular dysfunction and low mean aortic pressure gradient are at high risk of all-cause death after TAVI.

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