A new integrative approach to assess aortic stenosis burden and predict objective functional improvement after TAVR
Name
fcvm-10-1118409.pdf
Description
Published version
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1.45 MB
Format
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Checksum (MD5)
48b24fc1da3082da24bd5a07414a2f1f
Author(s)
de la Torre Hernandez, Jose M
Veiga Fernandez, Gabriela
Ben-Assa, Eyal
Sainz Laso, Fermin
Lee, Dae-Hyun
Ruisanchez Villar, Cristina
Lerena, Piedad
Garcia Camarero, Tamara
Cuesta Cosgaya, Jose M
Fradejas-Sastre, Victor
Date Issued
March 2, 2023
Journal
Frontiers in Cardiovascular Medicine
Publisher
Frontiers Media SA
Citation
de la Torre Hernandez JM, Veiga Fernandez G, Ben-Assa E, Sainz Laso F, Lee D-H, Ruisanchez Villar C, Lerena P, Garcia Camarero T, Cuesta Cosgaya JM, Fradejas-Sastre V, Benito M, Barrera S, Garcia-Unzueta MT, Brown J, Gil Ongay A, Zueco J, Vazquez de Prada JA and Edelman ER (2023) A new integrative approach to assess aortic stenosis burden and predict objective functional improvement after TAVR. Front. Cardiovasc. Med. 10:1118409.
Version
Final published version
Abstract
Background: A non-negligible rate of patients undergoing transcatheter aortic valve replacement (TAVR) do not report symptomatic improvement or even die in the short-midterm. We sought to assess the degree of objective functional recovery after TAVR and its prognostic implications and to develop a predictive model. Methods: In a cohort of patients undergoing TAVR, a prospective evaluation of clinical, anatomical, and physiological parameters was conducted before and after the procedure. These parameters were derived from echocardiography, non-invasive analysis of arterial pulse waves, and cardiac tomography. Objective functional improvement 6 months after TAVR was assessed using a 6-min walk test and nitro-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The derived predictive model was prospectively validated in a different cohort. A clinical follow-up was conducted at 2 years. Results: Among the 212 patients included, objective functional improvement was observed in 169 patients (80%) and subjective improvement in 187 (88%). Patients with objective functional improvement showed a much lower death rate at 2 years (9% vs. 31% p = 0.0002). Independent predictors of improvement were as follows: mean aortic gradient of ≥40 mmHg, augmentation index75 of ≥45%, the posterior wall thickness of ≤12 mm, and absence of atrial fibrillation. A simple integer-based point score was developed (GAPA score), which showed an area under the curve of 0.81 for the overall cohort and 0.78 for the low-gradient subgroup. In a validation cohort of 216 patients, these values were 0.75 and 0.76, respectively. Conclusion: A total of 80% of patients experienced objective functional improvement after TAVR, showing a significantly lower 2-year mortality rate. A predictive score was built that showed a good discriminative performance in overall and low-gradient populations.
MIT Department
Massachusetts Institute of Technology. Institute for Medical Engineering & Science
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DOI of Published Version
https://doi.org/10.3389/fcvm.2023.1118409
