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. 2023 Jul 24;24(8):1052-1061.
doi: 10.1093/ehjci/jead018.

Stroke volume index and transvalvular flow rate trajectories in severe aortic stenosis treated with TAVR

Guglielmo Gallone  1 , Fabian Islas  2 , Riccardo Gorla  3 , Francesco Melillo  4 , Pier Pasquale Leone  5   6 , Paolo Cimaglia  7 , Maria Concetta Pastore  8   9 , Anna Franzone  10 , Federico Landra  11 , Francesco Bruno  1 , Luca Scudeler  1 , Pilar Jimenez-Quevedo  2 , Tommaso Viva  3 , Francesco Piroli  4 , Renato Bragato  5   6 , Michele Trichilo  12 , Anna Degiovanni  8 , Federica Ilardi  10 , Alessandro Andreis  1 , Luis Nombela-Franco  2 , Tusa Maurizio  3 , Marco Toselli  7 , Federico Conrotto  1 , Matteo Montorfano  4 , Rachele Manzo  10 , Matteo Cameli  11 , Giuseppe Patti  8   9 , Giulio Stefanini  5   6 , Luca Testa  3 , Francesco Giannini  7 , Eustachio Agricola  4 , Javier Escaned  2 , Fabrizio D'Ascenzo  1 , Gaetano M De Ferrari  1
Affiliations

Stroke volume index and transvalvular flow rate trajectories in severe aortic stenosis treated with TAVR

Guglielmo Gallone et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: The prognostic impact of flow trajectories according to stroke volume index (SVi) and transvalvular flow rate (FR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains poorly assessed. We evaluated and compared SVi and FR prior and after TAVR for severe AS.

Methods and results: Patients were categorized according to SVi (<35 mL/m2) and FR (<200 mL/s). The association of pre- and post-TAVR SVi and FR with all-cause mortality up to 3 years was assessed with multivariable Cox regression models. Among 980 patients with pre-TAVR flow assessment, SVi was reduced in 41.3% and FR in 48.1%. Baseline flow status was not an independent mortality predictor [SVi: hazard ratio (HR) 1.22, 95% confidence interval (CI) 0.85-1.82, FR: HR 0.78, 95% CI 0.48-1.27]. Among 731 patients undergoing early (5 days, interquartile range 2-29) post-TAVR flow assessment, SVi recovered in 40.1% and FR in 49.0% patients with baseline low flow. Reduced FR following TAVR was an independent predictor of mortality (HR 1.67, 95% CI 1.02-2.74), whereas SVi was not (HR 0.97, 95% CI 0.53-1.78). Three-year estimated mortality in patients with recovered FR was lower than that in patients with reduced FR (13.3 vs. 37.7% vs, P = 0.003) and similar to that in patients with normal baseline FR (P = 0.317).

Conclusion: Baseline flow status was not an independent predictor of mid-term mortality among all-comers with severe AS undergoing TAVR. Flow recovery early after TAVR was frequent. Post-TAVR FR, but not SVi, was independently associated with mid-term all-cause mortality. By impacting flow status, AV replacement modifies the association of flow status with outcomes.

Keywords: aortic stenosis; low flow; stroke volume index; transcatheter aortic valve replacement; transvalvular flow rate.

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Conflict of interest statement

Conflict of interest: M.M. received consultant fees from Abbott, Boston Scientific, Kardia, and Medtronic. The other authors have no conflicts of interest to declare.