Cardiac Reversibility and Survival After Transcatheter Aortic Valve Implantation in Patients With Low‐Gradient Aortic Stenosis
Background Prognostic implications of transcatheter aortic valve implantation (TAVI) in low‐gradient (LG) aortic stenosis (AS) remain controversial. The authors hypothesized that differences in cardiac functional recovery may solve this ongoing controversy. The aim was to evaluate clinical outcomes...
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| Format: | Article |
| Language: | English |
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Wiley
2023-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.029717 |
| _version_ | 1797743210350510080 |
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| author | Kimi Sato Yoshihiro Seo Tomoko Ishizu Noor K. Albakaa Masaki Izumo Atsushi Okada Chisato Izumi Shu Inami Yasuharu Takeda Toshinari Onishi Yuki Izumi Akiko Kumagai Tomoko Fukuda Naohiko Takahashi Takeshi Kitai Hiroyuki Iwano Shigeo Sugawara Kazumi Akasaka Kenji Harada Yoshiko Masaoka Kenya Kusunose Kazuaki Tanabe Takahiro Sakamoto Takeshi Takamura Masaki Ieda |
| author_facet | Kimi Sato Yoshihiro Seo Tomoko Ishizu Noor K. Albakaa Masaki Izumo Atsushi Okada Chisato Izumi Shu Inami Yasuharu Takeda Toshinari Onishi Yuki Izumi Akiko Kumagai Tomoko Fukuda Naohiko Takahashi Takeshi Kitai Hiroyuki Iwano Shigeo Sugawara Kazumi Akasaka Kenji Harada Yoshiko Masaoka Kenya Kusunose Kazuaki Tanabe Takahiro Sakamoto Takeshi Takamura Masaki Ieda |
| author_sort | Kimi Sato |
| collection | DOAJ |
| description | Background Prognostic implications of transcatheter aortic valve implantation (TAVI) in low‐gradient (LG) aortic stenosis (AS) remain controversial. The authors hypothesized that differences in cardiac functional recovery may solve this ongoing controversy. The aim was to evaluate clinical outcomes and the response of left ventricular (LV) function following TAVI in patients with LG AS. Methods and Results This multicenter retrospective study included 1742 patients with severe AS undergoing TAVI between January 2015 and March 2019. Patients were subdivided into low‐flow (LF) LG, normal‐flow (NF) LG, LF high‐gradient, and NF high‐gradient AS groups according to the mean gradient of the aortic valve (LG <40 mm Hg) and LV stroke volume index (LF <35 mL/m2). Outcomes and changes in echocardiographic parameters after TAVI were compared between the groups. A total of 227 patients (13%) had reduced ejection fraction, and 486 patients (28%) had LG AS (LF‐LG 143 [8%]; NF‐LG 343 [20%]). During a median follow‐up period of 747 days, 301 patients experienced a composite end point of cardiovascular death and rehospitalization for cardiovascular events, which was higher in the LF‐LG and NF‐LG groups than in the high‐gradient groups. LG AS was independently associated with the primary outcome (hazard ratio, 1.69; P<0.001). Among 1239 patients with follow‐up echocardiography, LG AS showed less improvement in the LV mass index and LV end‐diastolic volume compared with high‐gradient AS after 1 year, while LV recovery was similar between the LF AS and NF AS groups. Conclusions LG AS was associated with poorer outcomes and LV recovery, regardless of flow status after TAVI. Careful evaluation of AS severity may be required in LG AS to provide TAVI within the appropriate time and advanced care afterward. |
| first_indexed | 2024-03-12T14:52:15Z |
| format | Article |
| id | doaj.art-f66e56fe71804521ab305efaf41faa72 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-12T14:52:15Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-f66e56fe71804521ab305efaf41faa722023-08-15T12:07:42ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-08-01121610.1161/JAHA.123.029717Cardiac Reversibility and Survival After Transcatheter Aortic Valve Implantation in Patients With Low‐Gradient Aortic StenosisKimi Sato0Yoshihiro Seo1Tomoko Ishizu2Noor K. Albakaa3Masaki Izumo4Atsushi Okada5Chisato Izumi6Shu Inami7Yasuharu Takeda8Toshinari Onishi9Yuki Izumi10Akiko Kumagai11Tomoko Fukuda12Naohiko Takahashi13Takeshi Kitai14Hiroyuki Iwano15Shigeo Sugawara16Kazumi Akasaka17Kenji Harada18Yoshiko Masaoka19Kenya Kusunose20Kazuaki Tanabe21Takahiro Sakamoto22Takeshi Takamura23Masaki Ieda24Department of Cardiology, Faculty of Medicine University of Tsukuba Tsukuba JapanDepartment of Cardiology Nagoya City University Graduate School of Medical Sciences Nagoya JapanDepartment of Cardiology, Faculty of Medicine University of Tsukuba Tsukuba JapanDepartment of Cardiology, Faculty of Medicine University of Tsukuba Tsukuba JapanDivision of Cardiology St. Marianna Medical University Hospital Kawasaki JapanDepartment of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka JapanDepartment of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka JapanDepartment of Cardiovascular Medicine Dokkyo Medical University Mibu JapanDepartment of Cardiovascular Medicine Osaka University Graduate School of Medicine Suita JapanDepartment of Cardiovascular Medicine Sakai City Hospital Organization Sakai JapanDepartment of Cardiology Sakakibara Heart Institute Tokyo JapanDivision of Cardiology, Department of Internal Medicine Iwate Medical University Iwate JapanDepartment of Cardiology and Clinical Examination, Faculty of Medicine Oita University Oita JapanDepartment of Cardiology and Clinical Examination, Faculty of Medicine Oita University Oita JapanDepartment of Cardiovascular Medicine National Cerebral and Cardiovascular Center Osaka JapanDepartment of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo JapanDepartment of Cardiology Nihonkai General Hospital Yamagata JapanMedical Laboratory and Blood Center Asahikawa Medical University Hospital Asahikawa JapanDivision of Cardiovascular Medicine, Department of Internal Medicine Jichi Medical University Tochigi JapanDepartment of Cardiology Hiroshima City Hiroshima Citizens Hospital Hiroshima JapanDepartment of Cardiovascular Medicine Tokushima University Hospital Tokushima JapanDivision of Cardiology Shimane University Faculty of Medicine Izumo JapanDivision of Cardiology Shimane University Faculty of Medicine Izumo JapanDepartment of Cardiology Ise Red Cross Hospital Ise JapanDepartment of Cardiology, Faculty of Medicine University of Tsukuba Tsukuba JapanBackground Prognostic implications of transcatheter aortic valve implantation (TAVI) in low‐gradient (LG) aortic stenosis (AS) remain controversial. The authors hypothesized that differences in cardiac functional recovery may solve this ongoing controversy. The aim was to evaluate clinical outcomes and the response of left ventricular (LV) function following TAVI in patients with LG AS. Methods and Results This multicenter retrospective study included 1742 patients with severe AS undergoing TAVI between January 2015 and March 2019. Patients were subdivided into low‐flow (LF) LG, normal‐flow (NF) LG, LF high‐gradient, and NF high‐gradient AS groups according to the mean gradient of the aortic valve (LG <40 mm Hg) and LV stroke volume index (LF <35 mL/m2). Outcomes and changes in echocardiographic parameters after TAVI were compared between the groups. A total of 227 patients (13%) had reduced ejection fraction, and 486 patients (28%) had LG AS (LF‐LG 143 [8%]; NF‐LG 343 [20%]). During a median follow‐up period of 747 days, 301 patients experienced a composite end point of cardiovascular death and rehospitalization for cardiovascular events, which was higher in the LF‐LG and NF‐LG groups than in the high‐gradient groups. LG AS was independently associated with the primary outcome (hazard ratio, 1.69; P<0.001). Among 1239 patients with follow‐up echocardiography, LG AS showed less improvement in the LV mass index and LV end‐diastolic volume compared with high‐gradient AS after 1 year, while LV recovery was similar between the LF AS and NF AS groups. Conclusions LG AS was associated with poorer outcomes and LV recovery, regardless of flow status after TAVI. Careful evaluation of AS severity may be required in LG AS to provide TAVI within the appropriate time and advanced care afterward.https://www.ahajournals.org/doi/10.1161/JAHA.123.029717low‐flow, low‐gradient ASlow‐gradient ASnormal‐flow, low‐gradient ASTAVI |
| spellingShingle | Kimi Sato Yoshihiro Seo Tomoko Ishizu Noor K. Albakaa Masaki Izumo Atsushi Okada Chisato Izumi Shu Inami Yasuharu Takeda Toshinari Onishi Yuki Izumi Akiko Kumagai Tomoko Fukuda Naohiko Takahashi Takeshi Kitai Hiroyuki Iwano Shigeo Sugawara Kazumi Akasaka Kenji Harada Yoshiko Masaoka Kenya Kusunose Kazuaki Tanabe Takahiro Sakamoto Takeshi Takamura Masaki Ieda Cardiac Reversibility and Survival After Transcatheter Aortic Valve Implantation in Patients With Low‐Gradient Aortic Stenosis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease low‐flow, low‐gradient AS low‐gradient AS normal‐flow, low‐gradient AS TAVI |
| title | Cardiac Reversibility and Survival After Transcatheter Aortic Valve Implantation in Patients With Low‐Gradient Aortic Stenosis |
| title_full | Cardiac Reversibility and Survival After Transcatheter Aortic Valve Implantation in Patients With Low‐Gradient Aortic Stenosis |
| title_fullStr | Cardiac Reversibility and Survival After Transcatheter Aortic Valve Implantation in Patients With Low‐Gradient Aortic Stenosis |
| title_full_unstemmed | Cardiac Reversibility and Survival After Transcatheter Aortic Valve Implantation in Patients With Low‐Gradient Aortic Stenosis |
| title_short | Cardiac Reversibility and Survival After Transcatheter Aortic Valve Implantation in Patients With Low‐Gradient Aortic Stenosis |
| title_sort | cardiac reversibility and survival after transcatheter aortic valve implantation in patients with low gradient aortic stenosis |
| topic | low‐flow, low‐gradient AS low‐gradient AS normal‐flow, low‐gradient AS TAVI |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.029717 |
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