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A new integrative approach to assess aortic stenosis burden and predict objective functional improvement after TAVR.
de la Torre Hernandez, Jose M; Veiga Fernandez, Gabriela; Ben-Assa, Eyal; Sainz Laso, Fermin; Lee, Dae-Hyun; Ruisanchez Villar, Cristina; Lerena, Piedad; Garcia Camarero, Tamara; Cuesta Cosgaya, Jose M; Fradejas-Sastre, Victor; Benito, Mercedes; Barrera, Sergio; Garcia-Unzueta, Maria T; Brown, Jonathan; Gil Ongay, Aritz; Zueco, Javier; Vazquez de Prada, Jose A; Edelman, Elazer R.
Afiliación
  • de la Torre Hernandez JM; Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
  • Veiga Fernandez G; Department of Cardiology, Medical School, University of Cantabria, Santander, Spain.
  • Ben-Assa E; Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
  • Sainz Laso F; Division of Cardiology, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel.
  • Lee DH; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States.
  • Ruisanchez Villar C; Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
  • Lerena P; Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
  • Garcia Camarero T; Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
  • Cuesta Cosgaya JM; Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
  • Fradejas-Sastre V; Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
  • Benito M; Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
  • Barrera S; Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
  • Garcia-Unzueta MT; Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
  • Brown J; Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
  • Gil Ongay A; Análisis clínicos, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
  • Zueco J; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States.
  • Vazquez de Prada JA; Cardiovascular Division, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States.
  • Edelman ER; Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain.
Front Cardiovasc Med ; 10: 1118409, 2023.
Article en En | MEDLINE | ID: mdl-36937938
Background: A non-negligible rate of patients undergoing transcatheter aortic valve replacement (TAVR) do not report symptomatic improvement or even die in the short-midterm. We sought to assess the degree of objective functional recovery after TAVR and its prognostic implications and to develop a predictive model. Methods: In a cohort of patients undergoing TAVR, a prospective evaluation of clinical, anatomical, and physiological parameters was conducted before and after the procedure. These parameters were derived from echocardiography, non-invasive analysis of arterial pulse waves, and cardiac tomography. Objective functional improvement 6 months after TAVR was assessed using a 6-min walk test and nitro-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The derived predictive model was prospectively validated in a different cohort. A clinical follow-up was conducted at 2 years. Results: Among the 212 patients included, objective functional improvement was observed in 169 patients (80%) and subjective improvement in 187 (88%). Patients with objective functional improvement showed a much lower death rate at 2 years (9% vs. 31% p = 0.0002). Independent predictors of improvement were as follows: mean aortic gradient of ≥40 mmHg, augmentation index75 of ≥45%, the posterior wall thickness of ≤12 mm, and absence of atrial fibrillation. A simple integer-based point score was developed (GAPA score), which showed an area under the curve of 0.81 for the overall cohort and 0.78 for the low-gradient subgroup. In a validation cohort of 216 patients, these values were 0.75 and 0.76, respectively. Conclusion: A total of 80% of patients experienced objective functional improvement after TAVR, showing a significantly lower 2-year mortality rate. A predictive score was built that showed a good discriminative performance in overall and low-gradient populations.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Prognostic_studies / Risk_factors_studies Idioma: En Revista: Front Cardiovasc Med Año: 2023 Tipo del documento: Article País de afiliación: España Pais de publicación: Suiza

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Prognostic_studies / Risk_factors_studies Idioma: En Revista: Front Cardiovasc Med Año: 2023 Tipo del documento: Article País de afiliación: España Pais de publicación: Suiza