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Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure

Background: Post-transcatheter aortic valve replacement (TAVR) patient outcome is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure (AugMAP)) derived from blood pre...

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Autores principales: Chao, Chieh-Ju, Agasthi, Pradyumna, Seri, Amith R., Barry, Timothy, Shanbhag, Anusha, Wang, Yuxiang, Eleid, Mackram F., Fortuin, David, Sweeney, John P., Pollak, Peter, El Sabbagh, Abdallah, Lester, Steven J., Freeman, William K., Naqvi, Tasneem Z., Holmes, David R., Appleton, Christopher P., Arsanjani, Reza
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10218897/
https://www.ncbi.nlm.nih.gov/pubmed/37233159
http://dx.doi.org/10.3390/jcdd10050192
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author Chao, Chieh-Ju
Agasthi, Pradyumna
Seri, Amith R.
Barry, Timothy
Shanbhag, Anusha
Wang, Yuxiang
Eleid, Mackram F.
Fortuin, David
Sweeney, John P.
Pollak, Peter
El Sabbagh, Abdallah
Lester, Steven J.
Freeman, William K.
Naqvi, Tasneem Z.
Holmes, David R.
Appleton, Christopher P.
Arsanjani, Reza
author_facet Chao, Chieh-Ju
Agasthi, Pradyumna
Seri, Amith R.
Barry, Timothy
Shanbhag, Anusha
Wang, Yuxiang
Eleid, Mackram F.
Fortuin, David
Sweeney, John P.
Pollak, Peter
El Sabbagh, Abdallah
Lester, Steven J.
Freeman, William K.
Naqvi, Tasneem Z.
Holmes, David R.
Appleton, Christopher P.
Arsanjani, Reza
author_sort Chao, Chieh-Ju
collection PubMed
description Background: Post-transcatheter aortic valve replacement (TAVR) patient outcome is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure (AugMAP)) derived from blood pressure and aortic valve gradients. Methods: Patients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between 1 January 2012 and 30 June 2017 were identified to retrieve baseline clinical, echocardiographic and mortality data. AugSBP, AugMAP and valvulo-arterial impedance (Zva) (Zva) were evaluated using Cox regression. Receiver operating characteristic curve analysis and the c-index were used to assess the model performance against the Society of Thoracic Surgeons (STS) risk score. Results: The final cohort contained 974 patients with a mean age of 81.4 ± 8.3 years old, and 56.6% were male. The mean STS risk score was 8.2 ± 5.2. The median follow-up duration was 354 days, and the one-year all-cause mortality rate was 14.2%. Both univariate and multivariate Cox regression showed that AugSBP and AugMAP parameters were independent predictors for intermediate-term post-TAVR mortality (all p < 0.0001). AugMAP1 < 102.5 mmHg was associated with a 3-fold-increased risk of all-cause mortality 1-year post-TAVR (hazard ratio 3.0, 95%confidence interval 2.0–4.5, p < 0.0001). A univariate model of AugMAP1 surpassed the STS score model in predicting intermediate-term post-TAVR mortality (area under the curve: 0.700 vs. 0.587, p = 0.005; c-index: 0.681 vs. 0.585, p = 0.001). Conclusions: Augmented mean arterial pressure provides clinicians with a simple but effective approach to quickly identify patients at risk and potentially improve post-TAVR prognosis.
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spelling pubmed-102188972023-05-27 Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure Chao, Chieh-Ju Agasthi, Pradyumna Seri, Amith R. Barry, Timothy Shanbhag, Anusha Wang, Yuxiang Eleid, Mackram F. Fortuin, David Sweeney, John P. Pollak, Peter El Sabbagh, Abdallah Lester, Steven J. Freeman, William K. Naqvi, Tasneem Z. Holmes, David R. Appleton, Christopher P. Arsanjani, Reza J Cardiovasc Dev Dis Article Background: Post-transcatheter aortic valve replacement (TAVR) patient outcome is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure (AugMAP)) derived from blood pressure and aortic valve gradients. Methods: Patients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between 1 January 2012 and 30 June 2017 were identified to retrieve baseline clinical, echocardiographic and mortality data. AugSBP, AugMAP and valvulo-arterial impedance (Zva) (Zva) were evaluated using Cox regression. Receiver operating characteristic curve analysis and the c-index were used to assess the model performance against the Society of Thoracic Surgeons (STS) risk score. Results: The final cohort contained 974 patients with a mean age of 81.4 ± 8.3 years old, and 56.6% were male. The mean STS risk score was 8.2 ± 5.2. The median follow-up duration was 354 days, and the one-year all-cause mortality rate was 14.2%. Both univariate and multivariate Cox regression showed that AugSBP and AugMAP parameters were independent predictors for intermediate-term post-TAVR mortality (all p < 0.0001). AugMAP1 < 102.5 mmHg was associated with a 3-fold-increased risk of all-cause mortality 1-year post-TAVR (hazard ratio 3.0, 95%confidence interval 2.0–4.5, p < 0.0001). A univariate model of AugMAP1 surpassed the STS score model in predicting intermediate-term post-TAVR mortality (area under the curve: 0.700 vs. 0.587, p = 0.005; c-index: 0.681 vs. 0.585, p = 0.001). Conclusions: Augmented mean arterial pressure provides clinicians with a simple but effective approach to quickly identify patients at risk and potentially improve post-TAVR prognosis. MDPI 2023-04-26 /pmc/articles/PMC10218897/ /pubmed/37233159 http://dx.doi.org/10.3390/jcdd10050192 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Chao, Chieh-Ju
Agasthi, Pradyumna
Seri, Amith R.
Barry, Timothy
Shanbhag, Anusha
Wang, Yuxiang
Eleid, Mackram F.
Fortuin, David
Sweeney, John P.
Pollak, Peter
El Sabbagh, Abdallah
Lester, Steven J.
Freeman, William K.
Naqvi, Tasneem Z.
Holmes, David R.
Appleton, Christopher P.
Arsanjani, Reza
Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure
title Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure
title_full Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure
title_fullStr Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure
title_full_unstemmed Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure
title_short Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure
title_sort transcatheter aortic valve replacement prognostication with augmented mean arterial pressure
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10218897/
https://www.ncbi.nlm.nih.gov/pubmed/37233159
http://dx.doi.org/10.3390/jcdd10050192
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