Clinical and Echocardiographic Parameters Predicting 1- and 2-Year Mortality After Transcatheter Aortic Valve Implantation

Didrik Kjønås; Henrik Schirmer; Svend Aakhus; Jo Eidet; Siri Malm; Lars Aaberge; Rolf Busund; Assami Rösner

doi:10.3389/fcvm.2021.739710

Clinical and Echocardiographic Parameters Predicting 1- and 2-Year Mortality After Transcatheter Aortic Valve Implantation

Front Cardiovasc Med. 2021 Dec 6:8:739710. doi: 10.3389/fcvm.2021.739710. eCollection 2021.

Authors

Didrik Kjønås¹, Henrik Schirmer^{2

3}, Svend Aakhus^{4

5}, Jo Eidet⁶, Siri Malm⁷, Lars Aaberge⁸, Rolf Busund^{9

10}, Assami Rösner¹

Affiliations

¹ Department of Cardiology, University Hospital of North Norway, Tromsø, Norway.
² Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.
³ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁴ Department of Circulation and Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
⁵ Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.
⁶ Department of Anesthesiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
⁷ Department of Cardiology, University Hospital of North Norway, Harstad, Norway.
⁸ Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
⁹ Institute of Clinical Medicine, The Arctic University of Norway (UiT), Tromsø, Norway.
¹⁰ Department of Cardiothoracic and Vascular Surgery, University Hospital of North Norway, Tromsø, Norway.

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has become a standard treatment option for patients with symptomatic aortic stenosis. Elderly high-risk patients treated with TAVI have a high residual mortality due to preexisting comorbidities. Knowledge of factors predicting futility after TAVI is sparse and clinical tools to aid the preoperative evaluation are lacking. The aim of this study was to evaluate if echocardiographic measures, including speckle-tracking analysis, in addition to clinical parameters, could aid in the prediction of mortality beyond 30 days after TAVI. Methods: This prospective observational cohort study included 227 patients treated with TAVI at the University Hospital of North Norway, Tromsø and Oslo University Hospital, Rikshospitalet from February 2010 to June 2013. All the patients underwent preoperative echocardiographic evaluation with retrospective speckle-tracking analysis. Primary endpoints were 1- and 2-year mortality beyond 30 days after TAVI. Results: All-cause 1- and 2-year mortality beyond 30 days after TAVI was 12.1 and 19.5%, respectively. Predictors of 1-year mortality beyond 30 days were body mass index [hazard ratio (HR): 0.88, 95% CI: 0.80-0.98, p = 0.018], previous myocardial infarction (HR: 2.69, 95% CI: 1.14-6.32, p = 0.023), and systolic pulmonary artery pressure ≥ 60 mm Hg (HR: 5.93, 95% CI: 1.67-21.1, p = 0.006). Moderate-to-severe mitral regurgitation (HR: 2.93, 95% CI: 1.53-5.63, p = 0.001), estimated glomerular filtration rate (HR: 0.98, 95% CI: 0.96-0.99, p = 0.002), and chronic obstructive pulmonary disease (HR: 1.9, 95% CI: 1.01-3.58, p = 0.046) were predictors of 2-year mortality. Conclusion: Both the clinical and echocardiographic parameters should be considered when evaluating high-risk patients for TAVI, as both are predictive of 1-and 2-year mortality. Our results support the importance of individual risk assessment using a multidisciplinary, multimodal, and individual approach.

Keywords: TAVI; echocardiography; mortality; risk assessment; strain.