RT Journal Article
SR Electronic
T1 Presence of mitral stenosis is a risk factor of new development of acute decompensated heart failure early after transcatheter aortic valve implantation
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e001348
DO 10.1136/openhrt-2020-001348
VO 7
IS 2
A1 Tsukasa Okai
A1 Kazuki Mizutani
A1 Masahiko Hara
A1 Tomohiro Yamaguchi
A1 Mana Ogawa
A1 Asahiro Ito
A1 Shinichi Iwata
A1 Yasuhiro Izumiya
A1 Yosuke Takahashi
A1 Toshihiko Shibata
A1 Minoru Yoshiyama
YR 2020
UL http://openheart.bmj.com/content/7/2/e001348.abstract
AB Aims Acute decompensated heart failure (ADHF) can occur early after transcatheter aortic valve implantation (TAVI), but the risk factors or mechanisms associated with it have not been fully determined. This hypothesis-generating study aimed to investigate the clinical indices associated with the development of ADHF within 72 hours after TAVI and to improve procedural approaches for TAVI.Method and results In this single-centre hypothesis generating prospective observational study, we enrolled 156 consecutive patients with severe aortic stenosis who underwent TAVI between January 2016 and February 2018 at our institution. We set the primary endpoint as the new development of ADHF within 72 hours after TAVI, and clinical indices associated with it were evaluated using a multivariable logistic model. The median age of the patients was 83 (quartile range 80–86) years, 48 (30.8%) were men and the median Society of Thoracic Surgery-Predicted Risk of Mortality was 7.1 (range 5.2–10.4). Mitral stenosis (MS), defined as mean transmitral valve pressure gradient ≥5 mm Hg, was present in 15 (9.6%) patients. After TAVI, the invasive mean transaortic valve pressure gradient (mAVPG) decreased from 48 (36–66) to 7 (5–11) mm Hg, and 12 (7.7%) patients developed ADHF within 72 hours after TAVI. Multivariable logistic regression analysis showed that MS (adjusted OR, 14.227; 95% CI 2.654 to 86.698; p=0.002) and greater decreases in mAVPG (1.038; 1.003 to 1.080; p=0.044) were associated with ADHF.Conclusions MS and drastic improvement of mAVPG were associated with new development of ADHF within 72 hours after TAVI.