First description and validation of a new method for estimating aortic stenosis burden and predicting the functional response to TAVI

Jose M de la Torre Hernandez; Gabriela Veiga Fernandez; Eyal Ben-Assa; Julia Iribarren; Fermin Sainz Laso; Dae-Hyun Lee; Cristina Ruisanchez Villar; Piedad Lerena; Tamara Garcia Camarero; Jose L Iribarren Sarrias; Jose M Cuesta Cosgaya; Maria E Maza Fernandez; Celia Garilleti; Victor Fradejas-Sastre; Mercedes Benito; Sergio Barrera; Aritz Gil Ongay; Jose A Vazquez de Prada; Javier Zueco

doi:10.3389/fcvm.2023.1215826

First description and validation of a new method for estimating aortic stenosis burden and predicting the functional response to TAVI

Front Cardiovasc Med. 2023 Nov 14:10:1215826. doi: 10.3389/fcvm.2023.1215826. eCollection 2023.

Authors

Jose M de la Torre Hernandez^{1

2}, Gabriela Veiga Fernandez¹, Eyal Ben-Assa³, Julia Iribarren⁴, Fermin Sainz Laso¹, Dae-Hyun Lee¹, Cristina Ruisanchez Villar¹, Piedad Lerena¹, Tamara Garcia Camarero¹, Jose L Iribarren Sarrias⁵, Jose M Cuesta Cosgaya¹, Maria E Maza Fernandez⁶, Celia Garilleti¹, Victor Fradejas-Sastre¹, Mercedes Benito¹, Sergio Barrera¹, Aritz Gil Ongay¹, Jose A Vazquez de Prada^{1

2}, Javier Zueco¹

Affiliations

¹ Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.
² Department of Cardiology, Medical School, University of Cantabria, Santander, Spain.
³ Cardiology Division, Assuta Ashdod University Hospital, Ben Gurion University, Ashdod, Israel.
⁴ School of Mathematics, Universidad de la Laguna, San Cristobal de la Laguna, Spain.
⁵ Intensive Care Unit, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, Spain.
⁶ Hydrodynamics and Coastal Infrastructures Group of IH Cantabria, Instituto de Hidraulica Ambiental, Universidad de Cantabria, Santander, Spain.

Abstract

Background: Up to one-fifth of patients continue to have poor quality of life after transcatheter aortic valve implantation (TAVI), with an additional similar proportion not surviving 1 year after the procedure. We aimed to assess the value of a new method based on an integrated analysis of left ventricular outflow tract flow velocity and aortic pressure to predict objective functional improvement and prognosis after TAVI.

Methods: In a cohort of consecutive patients undergoing TAVI, flow velocity-pressure integrated analysis was obtained from simultaneous pressure recordings in the ascending aorta and flow velocity recordings in the left ventricular outflow tract by echocardiography. Objective functional improvement 6 months after TAVI was assessed through changes in a 6-min walk test and NT-proBNP levels. A clinical follow-up was conducted at 2 years.

Results: Of the 102 patients studied, 82 (80.4%) showed objective functional improvement. The 2-year mortality of these patients was significantly lower (9% vs. 44%, p = 0.001). In multivariate analysis, parameter "(Pressure at Vmax - Pressure at Vo)/Vmax" was found to be an independent predictor for objective improvement. The C-statistic was 0.70 in the overall population and 0.78 in the low-gradient subgroup. All echocardiographic parameters and the valvuloarterial impedance showed a C-statistic of <0.6 for the overall and low-gradient patients. In a validation cohort of 119 patients, the C-statistic was 0.67 for the total cohort and 0.76 for the low-gradient subgroup.

Conclusion: This new method allows predicting objective functional improvement after TAVI more precisely than the conventional parameters used to assess the severity of aortic stenosis, particularly in low-gradient patients.

Keywords: aortic pressure; aortic stenosis; clinical outcomes; flow velocity; left ventricular outflow tract; transcatheter aortic valve implantation.

© 2023 de la Torre Hernandez, Veiga Fernandez, Ben-Assa, Iribarren, Sainz Laso, Lee, Ruisanchez Villar, Lerena, Garcia Camarero, Iribarren Sarrias, Cuesta Cosgaya, Maza Fernandez, Garilleti, Fradejas-Sastre, Benito, Barrera, Gil Ongay, Vazquez de Prada and Zueco.