Objectives To investigate whether preoperative echocardiographic evaluation of ventricular function, especially right ventricular systolic and diastolic parameters including speckle-tracking analysis, could aid in the prediction of 30-day mortality after transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis.
Methods This is a prospective observational cohort study including 227 patients accepted for TAVI at the University Hospital of North Norway and Oslo University Hospital from February 2010 through June 2013. All patients underwent preoperative transthoracic echocardiography with retrospective speckle-tracking analysis. Primary endpoint was all-cause 30-day mortality.
Results All-cause 30-day mortality was 8.7 % (n = 19). Independent predictors of 30-day mortality were systolic pulmonary arterial pressure (SPAP) > 60 mm Hg (HR: 7.7, 95% CI: 1.90 to 31.3), heart failure (HR: 2.9, 95% CI: 1.1 to 7.78), transapical access (HR: 3.8, 95% CI: 1.3 to 11.2), peripheral artery disease (HR: 6.0, 95% CI: 2.0 to 18.0) and body mass index (HR: 0.73, 95% CI: 0.61 to 0.87). C-statistic for the model generated was 0.91 (95% CI: 0.85 to 0.98). Besides elevated SPAP, no other echocardiographic measurements were found to be an independent predictor of early mortality.
Conclusion Except for elevated systolic pulmonary artery pressure, our data suggests that clinical rather than echocardiographic parameters are useful predictors of 30-day mortality after TAVI.
- quality and outcome
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Contributors AR, HS, RB and SA designed the protocol. AR, SA, GD, JE, SM, LA and RB collected the data. DK performed the data extraction and the offline calculations. DK did the statistical analysis and drafting of the first version of the manuscript in close cooperation with AR, HS, RB and SA. All authors contributed to the revision and all aspects of the final manuscript, and are guarantors of the study.
Funding DK received grant from the Regional Health Authorities of North Norway.
Competing interests Rolf Busund is a consultant for Edwards Lifesciences and has received speakers fee from Abbott. Lars Aaberge is a proctor for Edwards Lifesciences.
Patient consent for publication Obtained.
Ethics approval Regional Ethical Committees for Medical Research Ethics, North and South East Norway.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available upon reasonable request.
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