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Transthoracic echocardiography measures predict mortality risk after EVAR
Factors assessed through transthoracic echocardiography, such as the presence of mitral valve disease or a dilated tubular ascending aorta, were more predictive of mortality risk after endovascular aneurysm repair than conventional risk factors.
In a single-center, retrospective cohort study, researchers evaluated data from 273 patients who underwent transthoracic echocardiography before endovascular aneurysm repair (EVAR) between January 2008 and September 2010. The mean age of the patients was 73 years. Echocardiography was performed a mean of 18 days before EVAR.
The primary endpoint was all-cause mortality within 5 years of surgery, with follow-up at 6 weeks, 12 weeks and 6 months, then annual follow-up through December 2013 (mean follow-up, 3.2 years).
Echocardiography results indicated normal left ventricular ejection fraction in 78% of patients, mild impairment in 12%, moderate impairment in 8% and severe impairment in 2%. Mild dilation was observed in 5% of the cohort, with moderate dilation in 1% and severe dilation in 1%. Half of patients had mitral valve disease, including 101 with mild mitral regurgitation and 36 with moderate/severe regurgitation. Patients had a dilated tubular ascending aorta in 29% of cases.
Seventy-eight patients died during follow-up, with a mean time to death of 1.28 years. In unadjusted analysis, the mortality event rate was 3% per year among patients without mitral regurgitation, 15% in those with mild, 16% with moderate and 26% in those with severe regurgitation (P < .001). Among patients considered at low risk, the mortality rate was 1% per year, with an 8% rate at intermediate risk and a 16% rate at high risk (P < .001).
Factors associated with increased risk for all-cause mortality on multivariable analysis included diabetes (HR = 1.46; 95% CI, 1.24-1.89), a greater tubular ascending aorta (HR = 5.6; 95% CI, 2.77-11.33) and mitral regurgitation (HR = 8.13; 95% CI, 4.09-12.16). A lower LVEF (HR = 0.96; 95% CI, 0.93-0.98) and younger age (HR = 0.97; 95% CI, 0.95-0.99) were associated with reduced mortality risk. Inclusion of severity of mitral regurgitation into the model indicated that both mild (HR = 4.84; 95% CI, 2.8-13.92) and moderate/severe regurgitation (HR = 7; 95% CI, 3.52-13.92) were predictive of all-cause mortality.
“This large observational study of selected patients undergoing elective EVAR has identified for the first time that parameters routinely measured on [transthoracic echocardiography] are powerful predictors of long-term survival,” the researchers wrote. “These [transthoracic echocardiography] indices were more important at predicting outcome than standard conventional risk factors in this patient group and may serve as a useful tool for guiding clinical management.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.