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Multicenter Study
. 2021 Jun;8(3):1990-2001.
doi: 10.1002/ehf2.13270. Epub 2021 Mar 5.

Calculated plasma volume status and outcomes in patients undergoing transcatheter aortic valve replacement

Tetsuro Shimura  1 , Masanori Yamamoto  1   2 , Ryo Yamaguchi  1 , Yuya Adachi  1 , Mitsuru Sago  1 , Tatsuya Tsunaki  1 , Ai Kagase  2 , Yutaka Koyama  2 , Toshiaki Otsuka  3   4 , Fumiaki Yashima  5   6 , Norio Tada  7 , Toru Naganuma  8 , Masahiro Yamawaki  9 , Futoshi Yamanaka  10 , Shinichi Shirai  11 , Kazuki Mizutani  12 , Minoru Tabata  13 , Hiroshi Ueno  14 , Kensuke Takagi  15 , Yusuke Watanabe  16 , Kentaro Hayashida  6 ; OCEAN-TAVI investigators
Affiliations
Multicenter Study

Calculated plasma volume status and outcomes in patients undergoing transcatheter aortic valve replacement

Tetsuro Shimura et al. ESC Heart Fail. 2021 Jun.

Abstract

Aims: This study investigated the prognostic value of plasma volume status (PVS) in patients who underwent transcatheter aortic valve replacement (TAVR).

Methods and results: Plasma volume status was calculated in 2588 patients who underwent TAVR using data from the Japanese multicentre registry. All-cause mortality and heart failure hospitalization (HFH) within 2 years of TAVR were compared among the PVS quartiles (Q1, PVS < 5.5%; Q2, PVS 5.5-13.5%; Q3, PVS 13.5-21.0%; and Q4, PVS ≥ 21.0%). Subgroups were stratified by the PVS cut-off value combined with the New York Heart Association (NYHA) class as follows: low PVS with NYHA I/II (n = 959), low PVS with NYHA III/IV (n = 845), high PVS with NYHA I/II (n = 308), and high PVS with NYHA III/IV (n = 476). The cumulative all-cause mortality and HFH within 2 years of TAVR significantly increased with increasing PVS quartiles [8.5%, 16.8%, 19.2%, and 27.0% (P < 0.001) and 5.8%, 8.7%, 10.3%, and 12.9% (P < 0.001), respectively]. The high-PVS group regardless of the NYHA class had a higher all-cause mortality and HFH [9.6%, 18.2%, 24.5%, and 30.4% (P < 0.001) and 6.1%, 10.4%, 14.1%, and 11.3% (P < 0.001)]. In a Cox regression multivariate analysis, the PVS values of Q3 and Q4 had independently increased all-cause mortality [hazard ratio (HR), 1.50 and 1.64 (P = 0.017 and P = 0.008), respectively], and Q4 had independently increased HFH (HR, 1.98, P = 0.005). The low PVS with NYHA III/IV, high PVS with NYHA I/II, and high PVS with NYHA III/IV also had significantly increased all-cause mortality [HR, 1.45, 1.73, and 1.86 (P = 0.006, P = 0.002, and P < 0.001), respectively] and HFH [HR, 1.52, 2.21, and 1.70 (P = 0.049, P = 0.002, and P = 0.031), respectively].

Conclusions: Plasma volume status is useful for predicting all-cause mortality and HFH after TAVR.

Keywords: Heart failure; OCEAN-TAVI; Plasma volume status; TAVR; Transcatheter aortic valve replacement.

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Conflict of interest statement

M. Yamamoto, N.T., T.N., S.S., K.M., Y.W., H.U., and M.T. are clinical proctors of Edwards Lifesciences and Medtronic. Y.K., K.T., and K.H. are clinical proctors of Edwards Lifesciences. K.H. receives lecture fee from Edwards Lifesciences and Daiichi Sankyo Company. M. Yamamoto receives lecture fee from Edwards Lifesciences, Medtronic, and Daiichi Sankyo Company. S.S. receives lecture fee from Edwards Lifesciences, Medtronic, Abbott Vascular, and Daiichi Sankyo Company. Y.W. receives lecture fee from Edwards Lifesciences and Medtronic. T.N. receives lecture fee from Edwards Lifesciences and Medtronic. K.T. receives lecture fee from Edwards Lifesciences, Abbott, and Daiichi Sankyo Company. N.T. receives lecture fee from Edwards Lifesciences and Medtronic. M.T. receives lecture fee from Edwards Lifesciences, Medtronic, Terumo, Abbott, LivaNova, and Century Medical. K.M. receives lecture fee from Edwards Lifesciences, Abbott, Boston Scientific, Asteras Amgen, and Sanofi. H.U. receives lecture fee from Medtronic. F. Yashima receives lecture fee from Daiichi Sankyo Company. The remaining authors have nothing to disclose.

Figures

Figure 1
Figure 1
Distribution of the plasma volume status (PVS) in the OCEAN‐TAVI registry cohort (n = 2588).
Figure 2
Figure 2
Association between the New York Heart Association (NYHA) class and plasma volume status. The number of patients with NYHA class ≤II in each group tends to decrease across the four groups, whereas that of patients with NYHA Classes III and IV tends to increase.
Figure 3
Figure 3
Kaplan–Meier curves showing the study endpoints in the plasma volume status (PVS) groups defined by two differential PVS classifications. (A) Kaplan–Meier curves showing cumulative all‐cause mortality in PVS stratified by quartiles. (B) Kaplan–Meier curves showing the cumulative heart failure hospitalization (HFH) in PVS stratified by quartiles. (C) Kaplan–Meier curves showing the cumulative all‐cause mortality in the classification and regression tree (CART) stratified by the PVS subgroups. (D) Kaplan–Meier curves showing the cumulative HFH in the CART stratified by the PVS subgroups. (E) Kaplan–Meier curves showing the CART mortality in the groups stratified by PVS and the New York Heart Association (NYHA) class. (F) Kaplan–Meier curves showing the cumulative HFH in the groups stratified by the PVS and the NYHA class.
Figure 4
Figure 4
Landmark analysis of the heart failure readmission at 1 year and from 1 to 2 years in high‐plasma volume status (PVS) and low‐PVS groups. Landmark analysis showing the risk of heart failure hospitalization within 1 year and from 1 to 2 years in patients with severe aortic stenosis who underwent transcatheter aortic valve implantation.
See this image and copyright information in PMC

Comment in

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