LV stroke volume index predicts 1-year mortality after high-risk TAVR
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In adults with intermediate, high or extreme operative risk who underwent transcatheter aortic valve replacement, left ventricular stroke volume index 30 days after TAVR was an early predictor of 1‐year mortality, data show.
Imaging done immediately after TAVR but before discharge does not capture steady‐state hemodynamics, and whether or not a relationship between a steady‐state postprocedural LV stroke volume index and intermediate‐term mortality exists for contemporary unselected patients remains unknown, Benjamin S. Wessler, MD, MS, director of the Heart Valve Center at Tufts Medical Center, and colleagues wrote in Clinical Cardiology.
“While the overwhelming majority of patients with symptomatic aortic stenosis are offered TAVR, not all patients have hemodynamic improvement after TAVR,” Wessler told Healio. “Low stroke volume on echocardiography 30 days after TAVR identifies patients with worse survival at 1 year. More research is needed to understand if the causes of low stroke volume after TAVR can be targeted to improve outcomes.”
In a single-center, retrospective analysis, Wessler and colleagues analyzed data from 238 adults with a mean age of 81 years who underwent TAVR from 2017 to 2019 (55% men; average Society of Thoracic Surgeons risk score, 6.9). Researchers calculated echocardiographic LV stroke volume index at baseline and again at 30 days after TAVR. Patients were stratified by pre‐TAVR transaortic gradient, surgical risk and change in transvalvular flow after TAVR. Normal LV stroke volume index was defined as 35 mL/m2 or greater.
The 1‐year mortality rate was 9%, and 52% of patients had normal flow after TAVR.
Of those with pre‐TAVR low flow, 67% of patients did not have normalized LV stroke volume index at 30 days. Compared with low flow, 30‐day normal flow was associated with lower 1‐year mortality (4% vs. 14%; P = .007). This association persisted after adjusting for known predictors of risk, with an OR of 3.45 per 1 mL/m2 decrease (95% CI, 1.02-11.63; P = .046).
Within the cohort, 45% were deemed to have intermediate surgical risk and 55% had high or extreme surgical risk.
Normalized transvalvular flow after TAVR was associated with reduced mortality (8%) when compared with patients with persistent (15%) or new‐onset low flow (12%; P = .01).
The researchers noted that the data show the imaging finding can be used early after TAVR to identify patients unlikely to do well.
“As utilization of TAVR continues to rise and fewer patients receive medical therapy, this imaging finding may help identify patients early after TAVR who are at risk for worse 1‐year survival and for which additional interventions to improve LV stroke volume index should be considered,” the researchers wrote.
For more information:
Benjamin S. Wessler, MD, MS, can be reached at bwessler@tuftsmedicalcenter.org; Twitter: @benwessler.
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