PMID- 26175117
OWN - NLM
STAT- MEDLINE
DCOM- 20161031
LR  - 20181113
IS  - 1861-0692 (Electronic)
IS  - 1861-0684 (Linking)
VI  - 105
IP  - 1
DP  - 2016 Jan
TI  - Invasive hemodynamic assessments during transcatheter aortic valve implantation: 
      comparison of patient outcomes in higher vs. lower transvalvular gradients with 
      respect to left ventricular ejection fraction.
PG  - 59-71
LID - 10.1007/s00392-015-0889-1 [doi]
AB  - BACKGROUND: Low-flow and low-gradient (LFLG) aortic stenosis (AS), which can 
      occur with reduced or preserved left ventricular ejection fraction (LVEF), 
      represents a challenging patient subset. Since outcomes in patients with LFLG AS 
      are worse following surgical aortic valve replacement, we analyzed outcomes in 
      patients after transcatheter aortic valve implantation (TAVI) in our large 
      database. METHODS AND RESULTS: Among 841 treated patients, a total of 676 
      patients with complete dataset of invasive right- and left-sided hemodynamics 
      were analyzed. Patients were subdivided into normal flow, high-gradient AS (NFHG: 
      dPmean >40 mmHg, LVEF > 50%), paradoxical LFLG AS (PLFLG: dPmean </= 40 mmHg, LVEF 
      > 50%, stroke volume index </= 35 ml/m(2)), and classical LFLG AS (CLFLG: dPmean </= 
      40 mmHg, LVEF </= 30%). Finally, global hemodynamics and patient outcomes and were 
      compared. Patients with CLFLG AS had a higher prevalence of comorbidities and 
      much higher logistic euro SCORE (35.8 +/- 21.7) compared to PLFLG AS (20.0 +/- 13.1) 
      and NFHG AS (17.0 +/- 11.9). Despite high procedural success rates in all groups, 
      patients with CLFLG AS demonstrated a much higher 30-day and 1-year mortality 
      (NFHG/PLFLG/CLFLG 30-day: 5.9/9.6/18.3 %; 1-year: 11.4/22.4/38.2%). Nevertheless, 
      nearly all survivors demonstrated an improvement of functional capacity (NYHA 
      class) and a decrease of NTproBNP levels during the follow-up. CONCLUSION: The 
      higher mortality in patients with CLFLG AS reflects an advanced disease state, 
      possibly indicating a futile condition before TAVI. Nevertheless, high procedural 
      success rates and a functional improvement in nearly all survivors support the 
      concept of TAVI.
FAU - Schewel, Jury
AU  - Schewel J
AD  - Division of Cardiology, ASKLEPIOS Clinics St. Georg Hospital, Lohmuhlenstr. 5, 
      20099, Hamburg, Germany. j.schewel@asklepios.com.
FAU - Schewel, Dimitry
AU  - Schewel D
AD  - Division of Cardiology, ASKLEPIOS Clinics St. Georg Hospital, Lohmuhlenstr. 5, 
      20099, Hamburg, Germany.
FAU - Frerker, Christian
AU  - Frerker C
AD  - Division of Cardiology, ASKLEPIOS Clinics St. Georg Hospital, Lohmuhlenstr. 5, 
      20099, Hamburg, Germany.
FAU - Wohlmuth, Peter
AU  - Wohlmuth P
AD  - ASKLEPIOS Proresearch, Clinical Research and Development, Hamburg, Germany.
FAU - Kuck, Karl-Heinz
AU  - Kuck KH
AD  - Division of Cardiology, ASKLEPIOS Clinics St. Georg Hospital, Lohmuhlenstr. 5, 
      20099, Hamburg, Germany.
FAU - Schafer, Ulrich
AU  - Schafer U
AD  - Division of Cardiology, ASKLEPIOS Clinics St. Georg Hospital, Lohmuhlenstr. 5, 
      20099, Hamburg, Germany.
AD  - Division of Cardiology, University Heart Center Eppendorf, Hamburg, Germany.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20150716
PL  - Germany
TA  - Clin Res Cardiol
JT  - Clinical research in cardiology : official journal of the German Cardiac Society
JID - 101264123
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/physiopathology/*surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Transcatheter Aortic Valve Replacement/*methods
MH  - Treatment Outcome
MH  - Ventricular Function, Left/*physiology
OTO - NOTNLM
OT  - Low-flow low-gradient aortic stenosis
OT  - Patient outcome
OT  - Transcatheter aortic valve implantation
EDAT- 2015/07/16 06:00
MHDA- 2016/11/01 06:00
CRDT- 2015/07/16 06:00
PHST- 2015/05/07 00:00 [received]
PHST- 2015/07/03 00:00 [accepted]
PHST- 2015/07/16 06:00 [entrez]
PHST- 2015/07/16 06:00 [pubmed]
PHST- 2016/11/01 06:00 [medline]
AID - 10.1007/s00392-015-0889-1 [pii]
AID - 10.1007/s00392-015-0889-1 [doi]
PST - ppublish
SO  - Clin Res Cardiol. 2016 Jan;105(1):59-71. doi: 10.1007/s00392-015-0889-1. Epub 
      2015 Jul 16.