Prognostic Impact of the Get-with-the-Guidelines Heart-Failure Risk Score (GWTG-HF) after Transcatheter Aortic Valve Replacement in Patients with Low-Flow–Low-Gradient Aortic Valve Stenosis
Objectives: This study examined the prognostic value of the get-with-the-guidelines heart-failure risk score (GWTG-HF) on mortality in patients with low-flow–low-gradient aortic valve stenosis (LFLG-AS) after transcatheter aortic valve implantation (TAVI). Background: Data on feasibility of TAVI and...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/7/1357 |
| _version_ | 1797608119114661888 |
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| author | Clemens Eckel Johannes Blumenstein Oliver Husser Dagmar Sötemann Christina Grothusen Judith Schlüter Marc Becher Holger Nef Albrecht Elsässer Georg Nickenig Helge Möllmann Vedat Tiyerili |
| author_facet | Clemens Eckel Johannes Blumenstein Oliver Husser Dagmar Sötemann Christina Grothusen Judith Schlüter Marc Becher Holger Nef Albrecht Elsässer Georg Nickenig Helge Möllmann Vedat Tiyerili |
| author_sort | Clemens Eckel |
| collection | DOAJ |
| description | Objectives: This study examined the prognostic value of the get-with-the-guidelines heart-failure risk score (GWTG-HF) on mortality in patients with low-flow–low-gradient aortic valve stenosis (LFLG-AS) after transcatheter aortic valve implantation (TAVI). Background: Data on feasibility of TAVI and mortality prediction in the LFLG-AS population are scarce. Clinical risk assessment in this particular population is difficult, and a score has not yet been established for this purpose. Methods: A total of 212 heart failure (HF) patients with real LFLG-AS were enrolled. Patients were classified into low-risk (<i>n</i> = 108), intermediate-risk (<i>n</i> = 90) and high-risk (<i>n</i> = 14) groups calculated by the GWTG-HF score. Clinical outcomes of cardiovascular events according to Valve Academic Research Consortium (VARC-2) recommendations and composite endpoint of death and hospitalization for heart failure (HHF) were assessed at discharge and 1 year of follow-up. Results: Baseline parameters of the groups showed a median age of 81.0 years [77.0; 84.0] (79.0 vs. 82.0 vs. 86.0, respectively <i>p</i> < 0.001), median EuroSCORE II of 6.6 [4.3; 10.7] (5.5 vs. 7.2 vs. 9.1, <i>p</i> = 0.004) and median indexed stroke volume of 26.7 mL/m<sup>2</sup> [22.0; 31.0] (28.2 vs. 25.8 vs. 25.0, <i>p</i> = 0.004). The groups significantly differed at follow-up in terms of all-cause mortality (10.2 vs. 21.1 vs. 28.6%; <i>p</i> < 0.035). There was no difference in intrahospital event rate (VARC). Postprocedural mean gradients were lower in high-risk group (7.0 vs. 7.0 vs. 5.0 mmHg, <i>p</i> = 0.011). No differences in postprocedural aortic valve area (1.9 vs. 1.7 vs. 1.9 cm<sup>2</sup>, <i>p</i> = 0.518) or rate of device failure (5.6 vs. 6.8 vs. 7.7%, <i>p</i> = 0.731) could be observed. After adjustment for known predictors, the GWTG score (HR 1.07 [1.01–1.14], <i>p</i> = 0.030) as well as pacemaker implantation (HR 3.97 [1.34–11.75], <i>p</i> = 0.013) turned out to be possible predictors for mortality. An increase in stroke volume index (SVI) was, in contrast, protective (HR 0.90 [0.83–0.97]; <i>p</i> = 0.006). Conclusions: The GWTG score may predict mortality after TAVI in LFLG-AS HF patients. Interestingly, all groups showed similar intrahospital event and mortality rates, independent of calculated mortality risk. Low SVI and new conduction disturbances associated with PPI after THV implantation had negative impact on mid-term outcome in post-TAVI HF-patients. |
| first_indexed | 2024-03-11T05:40:08Z |
| format | Article |
| id | doaj.art-b3918f4d1e0c4d3d9e07597fa2276ec6 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T05:40:08Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-b3918f4d1e0c4d3d9e07597fa2276ec62023-11-17T16:31:29ZengMDPI AGDiagnostics2075-44182023-04-01137135710.3390/diagnostics13071357Prognostic Impact of the Get-with-the-Guidelines Heart-Failure Risk Score (GWTG-HF) after Transcatheter Aortic Valve Replacement in Patients with Low-Flow–Low-Gradient Aortic Valve StenosisClemens Eckel0Johannes Blumenstein1Oliver Husser2Dagmar Sötemann3Christina Grothusen4Judith Schlüter5Marc Becher6Holger Nef7Albrecht Elsässer8Georg Nickenig9Helge Möllmann10Vedat Tiyerili11Department of Cardiology, St.-Johannes-Hospital, 44137 Dortmund, GermanyDepartment of Cardiology, St.-Johannes-Hospital, 44137 Dortmund, GermanyDepartment of Cardiology, St.-Johannes-Hospital, 44137 Dortmund, GermanyDepartment of Cardiology, St.-Johannes-Hospital, 44137 Dortmund, GermanyDepartment of Cardiology, St.-Johannes-Hospital, 44137 Dortmund, GermanyDepartment of Cardiology, St.-Johannes-Hospital, 44137 Dortmund, GermanyDepartment of Cardiology, University of Bonn, Heart Center Bonn, 53113 Bonn, GermanyDepartment of Cardiology, University of Gießen, 35390 Gießen, GermanyDepartment of Cardiology, University of Oldenburg, 26129 Oldenburg, GermanyDepartment of Cardiology, University of Bonn, Heart Center Bonn, 53113 Bonn, GermanyDepartment of Cardiology, St.-Johannes-Hospital, 44137 Dortmund, GermanyDepartment of Cardiology, St.-Johannes-Hospital, 44137 Dortmund, GermanyObjectives: This study examined the prognostic value of the get-with-the-guidelines heart-failure risk score (GWTG-HF) on mortality in patients with low-flow–low-gradient aortic valve stenosis (LFLG-AS) after transcatheter aortic valve implantation (TAVI). Background: Data on feasibility of TAVI and mortality prediction in the LFLG-AS population are scarce. Clinical risk assessment in this particular population is difficult, and a score has not yet been established for this purpose. Methods: A total of 212 heart failure (HF) patients with real LFLG-AS were enrolled. Patients were classified into low-risk (<i>n</i> = 108), intermediate-risk (<i>n</i> = 90) and high-risk (<i>n</i> = 14) groups calculated by the GWTG-HF score. Clinical outcomes of cardiovascular events according to Valve Academic Research Consortium (VARC-2) recommendations and composite endpoint of death and hospitalization for heart failure (HHF) were assessed at discharge and 1 year of follow-up. Results: Baseline parameters of the groups showed a median age of 81.0 years [77.0; 84.0] (79.0 vs. 82.0 vs. 86.0, respectively <i>p</i> < 0.001), median EuroSCORE II of 6.6 [4.3; 10.7] (5.5 vs. 7.2 vs. 9.1, <i>p</i> = 0.004) and median indexed stroke volume of 26.7 mL/m<sup>2</sup> [22.0; 31.0] (28.2 vs. 25.8 vs. 25.0, <i>p</i> = 0.004). The groups significantly differed at follow-up in terms of all-cause mortality (10.2 vs. 21.1 vs. 28.6%; <i>p</i> < 0.035). There was no difference in intrahospital event rate (VARC). Postprocedural mean gradients were lower in high-risk group (7.0 vs. 7.0 vs. 5.0 mmHg, <i>p</i> = 0.011). No differences in postprocedural aortic valve area (1.9 vs. 1.7 vs. 1.9 cm<sup>2</sup>, <i>p</i> = 0.518) or rate of device failure (5.6 vs. 6.8 vs. 7.7%, <i>p</i> = 0.731) could be observed. After adjustment for known predictors, the GWTG score (HR 1.07 [1.01–1.14], <i>p</i> = 0.030) as well as pacemaker implantation (HR 3.97 [1.34–11.75], <i>p</i> = 0.013) turned out to be possible predictors for mortality. An increase in stroke volume index (SVI) was, in contrast, protective (HR 0.90 [0.83–0.97]; <i>p</i> = 0.006). Conclusions: The GWTG score may predict mortality after TAVI in LFLG-AS HF patients. Interestingly, all groups showed similar intrahospital event and mortality rates, independent of calculated mortality risk. Low SVI and new conduction disturbances associated with PPI after THV implantation had negative impact on mid-term outcome in post-TAVI HF-patients.https://www.mdpi.com/2075-4418/13/7/1357heart failureTHVlow flow–low gradientaortic valve stenosisget-with-the-guidelines heart-failure risk scoreGWTG-HF |
| spellingShingle | Clemens Eckel Johannes Blumenstein Oliver Husser Dagmar Sötemann Christina Grothusen Judith Schlüter Marc Becher Holger Nef Albrecht Elsässer Georg Nickenig Helge Möllmann Vedat Tiyerili Prognostic Impact of the Get-with-the-Guidelines Heart-Failure Risk Score (GWTG-HF) after Transcatheter Aortic Valve Replacement in Patients with Low-Flow–Low-Gradient Aortic Valve Stenosis Diagnostics heart failure THV low flow–low gradient aortic valve stenosis get-with-the-guidelines heart-failure risk score GWTG-HF |
| title | Prognostic Impact of the Get-with-the-Guidelines Heart-Failure Risk Score (GWTG-HF) after Transcatheter Aortic Valve Replacement in Patients with Low-Flow–Low-Gradient Aortic Valve Stenosis |
| title_full | Prognostic Impact of the Get-with-the-Guidelines Heart-Failure Risk Score (GWTG-HF) after Transcatheter Aortic Valve Replacement in Patients with Low-Flow–Low-Gradient Aortic Valve Stenosis |
| title_fullStr | Prognostic Impact of the Get-with-the-Guidelines Heart-Failure Risk Score (GWTG-HF) after Transcatheter Aortic Valve Replacement in Patients with Low-Flow–Low-Gradient Aortic Valve Stenosis |
| title_full_unstemmed | Prognostic Impact of the Get-with-the-Guidelines Heart-Failure Risk Score (GWTG-HF) after Transcatheter Aortic Valve Replacement in Patients with Low-Flow–Low-Gradient Aortic Valve Stenosis |
| title_short | Prognostic Impact of the Get-with-the-Guidelines Heart-Failure Risk Score (GWTG-HF) after Transcatheter Aortic Valve Replacement in Patients with Low-Flow–Low-Gradient Aortic Valve Stenosis |
| title_sort | prognostic impact of the get with the guidelines heart failure risk score gwtg hf after transcatheter aortic valve replacement in patients with low flow low gradient aortic valve stenosis |
| topic | heart failure THV low flow–low gradient aortic valve stenosis get-with-the-guidelines heart-failure risk score GWTG-HF |
| url | https://www.mdpi.com/2075-4418/13/7/1357 |
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