TY - JOUR T1 - Prognostic impact of postprocedure stroke volume in patients with low-gradient aortic stenosis JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2018-000988 VL - 6 IS - 1 SP - e000988 AU - Yugo Nara AU - Akihisa Kataoka AU - Yusuke Watanabe AU - Nakashima Makoto AU - Hirofumi Hioki AU - Hideyuki Kawashima AU - Nagura Fukuko AU - Ken Kozuma AU - Shinichi Shirai AU - Norio Tada AU - Motoharu Araki AU - Toru Naganuma AU - Futoshi Yamanaka AU - Hiroshi Ueno AU - Minoru Tabata AU - Kazuki Mizutani AU - Akihiro Higashimori AU - Kensuke Takagi AU - Masanori Yamamoto AU - Kentaro Hayashida Y1 - 2019/05/01 UR - http://openheart.bmj.com/content/6/1/e000988.abstract N2 - Objective The effect of postoperative blood flow status on the prognosis of patients with low-gradient severe aortic stenosis (AS) has not been examined. Severe AS is associated with a higher mortality rate after transcatheter aortic valve implantation (TAVI). We examined the prognostic value of low-flow status by comparing stroke volume indices (SVi) before and after TAVI in patients with symptomatic, low-gradient severe AS.Methods A total of 1613 patients with severe symptomatic AS who underwent TAVI in 14 Japanese institutes for low-gradient severe AS (418 patients, median age 84 years, 32.5% men) were prospectively enrolled. The primary endpoint was cardiovascular mortality during follow-up after TAVI, and independent predictors were evaluated. Receiver operating characteristic curves were generated to determine the optimal cut-off value of post-TAVI SVi for predicting cardiovascular mortality, and the receiver operating characteristic curves of pre-TAVI and post-TAVI SVi were compared.Results The cardiovascular mortality rate was 4.1% (17 patients) during follow-up (median 9.2 months). Multivariate analysis revealed post-TAVI SVi to be an independent predictor of cardiovascular mortality (per 10 mL/m2 decrease; HR, 2.0; 95% CI 1.28 to 3.12). The optimal cut-off value of post-TAVI SVi was 41.4 mL/m2. Post-TAVI SVi showed significantly larger area under the curve than pre-TAVI SVi (0.74 (95% CI 0.69 to 0.79) vs 0.61 (95% CI 0.56 to 0.65), p<0.05).Conclusions Post-TAVI SVi is a better predictor of cardiovascular mortality than pre-TAVI SVi in patients with symptomatic low-gradient severe AS. Low-flow and low-normal-flow status (35≤ SVi <40 mL/m2) require careful management after TAVI. ER -