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. 2023 Jan;46(1):76-83.
doi: 10.1002/clc.23937. Epub 2022 Oct 23.

Left ventricular stroke volume index following transcatheter aortic valve replacement is an early predictor of 1-year survival

Shiva K Annamalai  1 , Benjamin C Koethe  1 , Eli Simsolo  1 , Dou Huang  2 , Ann Connors  1 , Charles D Resor  1 , Andrew R Weintraub  1 , Natesa G Pandian  1 , Brian C Downey  1 , Ayan R Patel  1 , Benjamin S Wessler  1
Affiliations

Left ventricular stroke volume index following transcatheter aortic valve replacement is an early predictor of 1-year survival

Shiva K Annamalai et al. Clin Cardiol. 2023 Jan.

Abstract

Background: Adverse cardiac events are common following transcatheter aortic valve replacement (TAVR). Our aim was to investigate the low left ventricular stroke volume index (LVSVI) 30 days after TAVR as an early echocardiographic marker of survival.

Hypothesis: Steady-state (30-day) LVSVI after TAVR is associated with 1-year mortality.

Methods: A single-center retrospective analysis of all patients undergoing TAVR from 2017 to 2019. Baseline and 30-day post-TAVR echocardiographic LVSVI were calculated. Patients were stratified by pre-TAVR transaortic gradient, surgical risk, and change in transvalvular flow following TAVR.

Results: This analysis focuses on 238 patients treated with TAVR. The 1-year mortality rate was 9% and 124 (52%) patients had normal flow post-TAVR. Of those with pre-TAVR low flow, 67% of patients did not normalize LVSVI at 30 days. The 30-day normal flow was associated with lower 1-year mortality when compared to low flow (4% vs. 14%, p = .007). This association remained significant after adjusting for known predictors of risk (adjusted odds ratio [OR] of 3.45, 95% confidence interval: 1.02-11.63 [per 1 ml/m2 decrease], p = .046). Normalized transvalvular flow following TAVR was associated with reduced mortality (8%) when compared to those with persistent (15%) or new-onset low flow (12%) (p = .01).

Conclusions: LVSVI at 30 days following TAVR is an early echocardiographic predictor of 1-year mortality and identifies patients with worse intermediate outcomes. More work is needed to understand if this short-term imaging marker might represent a novel therapeutic target.

Keywords: TAVR; echocardiography; stroke volume index.

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Figures

Figure 1
Figure 1
Reclassification of indexed LVOT‐derived stroke volume after TAVR. The primary analytic cohort includes patients with pre‐ and 30‐day postechocardiograms (N = 238). iSV, indexed stroke volume; LVOT, left ventricular outflow tract; ml, milliliter, m2, meters squared; TAVR, transcatheter aortic valve replacement.
Figure 2
Figure 2
One‐year mortality among patients undergoing transcatheter aortic valve replacement when dichotomized by 30‐day follow‐up left ventricular stroke volume index (LVSVI) < or ≥35 ml/m2
Figure 3
Figure 3
One‐year mortality among patients undergoing transcatheter aortic valve replacement when stratified by both 30‐day follow‐up LVSVI < or ≥35 ml/m2, as well as preprocedural transvalvular gradient. LVSVI, left ventricular stroke volume index; TAVR, transcatheter aortic valve replacement.
Figure 4
Figure 4
(A) Distributions of transvalvular flow states following a transcatheter aortic valve replacement. (B) Relationship between transvalvular flow states and 1‐year mortality. LF, low flow, NF, normal flow.
See this image and copyright information in PMC

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