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Effect of Sex and Flow Status on Outcomes After Surgical or Transcatheter Aortic Valve Replacement.
Carter-Storch, Rasmus; Hahn, Rebecca T; Abbas, Amr E; Daubert, Melissa A; Douglas, Pamela S; Elmariah, Sammy; Zhao, Yanglu; Mack, Michael J; Leon, Martin B; Pibarot, Philippe; Clavel, Marie-Annick.
Afiliación
  • Carter-Storch R; Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada.
  • Hahn RT; Department of Cardiology, Odense University Hospital, Odense, Denmark.
  • Abbas AE; Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
  • Daubert MA; Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan, USA.
  • Douglas PS; Duke University, Durham, North Carolina, USA.
  • Elmariah S; Duke University, Durham, North Carolina, USA.
  • Zhao Y; Massachusetts General Hospital, Boston, Massachusetts, USA.
  • Mack MJ; Edwards Lifesciences, Irvine, California, USA.
  • Leon MB; Baylor Scott & White Health, Plano, Texas, USA.
  • Pibarot P; Columbia University, New York, New York, USA.
  • Clavel MA; Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada.
JACC Adv ; 3(3): 100853, 2024 Mar.
Article en En | MEDLINE | ID: mdl-38938841
ABSTRACT

Background:

Low stroke volume index <35 ml/m2 despite preserved ejection fraction (paradoxical low flow [PLF]) is associated with adverse outcomes in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). However, whether the risk associated with PLF is similar in both sexes is unknown.

Objectives:

The purpose of this study was to analyze the risk associated with PLF in severe aortic stenosis for men and women randomized to TAVR or SAVR.

Methods:

Patients with ejection fraction ≥50% from the PARTNER (Placement of Aortic Transcatheter Valves) 2 and 3 trials were stratified by sex and treatment arm. The impact of PLF on the 2-year occurrence of the composite of death or heart failure hospitalization (primary endpoint) and of all-cause mortality alone (secondary endpoint) was analyzed. Analysis of variance was used to assess baseline differences between groups. Multivariate Cox regression analysis was used to identify predictors of the endpoint.

Results:

Out of 2,242 patients, PLF was present in 390 men and 239 women (30% vs 26%, P = 0.06). PLF was associated with a higher rate of NYHA functional class III to IV dyspnea (60% vs 54%, P < 0.001) and a higher prevalence of atrial fibrillation (39% vs 24%, P < 0.001). PLF was a significant predictor of the primary endpoint among women undergoing SAVR in multivariate analysis (adjusted HR 2.25 [95% CI 1.14-4.43], P = 0.02) but was not associated with a worse outcome in any of the other groups (all P > 0.05).

Conclusions:

In women with PLF, TAVR may improve outcomes compared to SAVR. PLF appears to have less impact on outcomes in men.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: JACC Adv Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: JACC Adv Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos