The Predictive Value of Left Ventricular End-Diastolic Pressure on Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

Chen, Kai

The Predictive Value of Left Ventricular End-Diastolic Pressure on Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Kai Chen , University of Miami/ JFK Medical Center Palm Beach Regional Consortium, Atlantis, FL

Abdulah Alrifai , University of Miami Palm Beach Regional Campus, Atlantis, FL

Mohamad Kabach , University of Miami Palm Beach Regional Campus, Atlantis, FL

Jesus E. Pino, M.D. , University of Miami/ JFK Medical Center Palm Beach Regional Consortium, Atlantis, FL

Elie Donath, M.D. , University of Miami/ JFK Medical Center Palm Beach Regional Consortium, Atlantis, FL

Lawrence Lovitz, M.D. , JFK Medical Center, Atlantis, FL

Mark Rothenberg , University of Miami Palm Beach Regional Campus, Atlantis, FL

Roberto Cubeddu, M.D. , Cleveland Clinic Florida, Weston, FL

Robert Chait, M.D. , University of Miami Palm Beach Regional Campus, Atlantis, FL

Marcos Nores, MD , JFK Medical Center, Atlantis, FL

Background:
Left ventricular end-diastolic pressure (LVEDP) is a practical marker of hemodynamic status in patients with severe aortic stenosis. LVEDP has been suggested as an independent predictor of outcome in aortic valve surgeries. In this study we investigate the predictive value of LVEDP in patients undergoing transcatheter aortic valve replacement (TAVR).

Methods:
We identified consecutive patients with severe aortic stenosis presenting to our cardiovascular center for TAVR between April 2012 and January 2017. Patients were divided into 4 subgroups according to their baseline LVEDP including ≤15mm Hg, 16-20mm Hg, 21-25mm Hg, and ≥26mm Hg. Outcomes included 30-day mortality, one-year mortality, and post-procedural complications.

Results:
A total of 382 patients were included in this retrospective observational study. Of these patients, 49 (12.8%) had LVEDP ≤15mm Hg, 106 (27.7%) were 16-20mm Hg, 106 (27.7%) were 21-25mm Hg, and 121 (31.7%) were ≥26mm Hg. Baseline characteristics were similar across the 4 subgroups, except low LVEDP ≤15mm Hg were significantly older. There was no significant difference in post-procedural complications including strokes (p=0.521), complete heart block (p=0.358), new-onset atrial fibrillation (p=0.122), or acute kidney injury (p=0.102). There was no significant difference in 30-day mortality (p=0.912). Although not significant, higher LVEDP groups appeared more likely to be dead at one year, 3/49 (6.1%) for ≤15mm Hg, 9/106 (8.5%) for 16-20mm Hg, 11/106 (10.4%) for 21-25mm Hg, and 18/121 (14.9%) for ≥26mm Hg (p=0.281). Multivariate logistic regression analysis revealed LVEDP is highly statistically significantly associated with one-year mortality after TAVR, whereby each increase in 1mm Hg increases risk of death by 3.9% (OR 1.039, 95% CI 1.009-1.068, p<0.01).

Conclusions:
This study suggests LVEDP can be utilized as an prognostic predictor in patients undergoing TAVR.