Background/Introduction In the era transcatheter aortic valve replacement (TAVR), predicting post-procedural outcome of patients is one of the most important goals in structural heart research. We proposed new parameters (augmented blood pressure) derived from blood pressure and aortic valve gradient measurements and hypothesized that they can predict post-TAVR 1-year mortality. Materials and Methods Patients in the Mayo Clinic National Cardiovascular Diseases Registry (NCDR)-TAVR database who underwent TAVR between January 1, 2014 and June 30, 2017 were identified to retrieve baseline demographics, STS risk score ECG, cardiac computed tomography, echocardiographic and mortality data. Augmented blood pressure parameters and valvulo-arterial impedance were evaluated by Cox regression. After logistic model generation, receiver operating curve analysis was used to assess the model performance against STS risk score. Results The final cohort contains 883 patients. The mean age is 81.3+/-8.5 years old, 58.2% are male. The mean STS risk score is 8.1+/-5.1. The median follow-up duration is 353 days and one-year all-cause mortality rates is 13.3%. Multivariate Cox regression showed that augmented SBP and augmented MAP parameters are independently predictors of 1-year mortality (all p<0.0001). A single-parameter model based on augmented MAP1 supersedes STS risk score in prediction mortality (AUC 0.697 vs. 0.591, p=0.0055). Conclusion Augmented mean arterial pressure provides a simple but effective approach for clinicians to quickly estimate the clinical outcome of TAVR patients and should be incorporated in the assessment of TAVR candidacy.

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BackgroundRecent studies have shown that patients with moderate aortic stenosis and reduced left ventricular ejection fraction may benefit from earlier intervention instead of periodic surveillance. Identifying patients at higher risk is therefore warranted concerning the possibility of expanding aortic valve replacement indication.ObjectiveWe aim to investigate the usefulness of a novel echo-marker, augmented mean arterial pressure (AugMAP), in identifying high-risk patients with moderate aortic stenosis.MethodsAdult patients with moderate aortic stenosis (aortic valve area 1.0-1.5 cm2) at Mayo Clinic sites in 1/2010-12/2020 were identified. Baseline demographics, echocardiography, and all-cause mortality data were retrieved. Patients were grouped into higher and lower AugMAP groups using a cutoff of 80 mmHg for analysis. Kaplan-Meier and Cox regression analyses were used to assess the performance of AugMAP.ResultsA total of 4,563 patients with moderate aortic stenosis were included. The mean age was 73.7±12.5 years and 60.5 % were male. The median follow-up was 2.5 years, and 36.0% of patients died. The mean LVEF was 60.1 ± 11.4%, and the mean AugMAP was 99.1 ± 13.1 mmHg. Patients in the lower AugMAP group, with either preserved or reduced LVEF, had significantly worse survival performance (all p< 0.0001). Multivariate Cox regression showed that AugMAP was independently associated with all-cause mortality after adjusting for age, sex, and LVEF (HR: 0.99 per unit increase, 95%CI: 0.978-0.996, p=0.01).ConclusionAugMAP is a simple and effective echo-maker beyond LVEF to identify high-risk moderate aortic stenosis patients who may benefit more from earlier intervention.Condensed abstractPatients with moderate aortic stenosis and reduced left ventricular ejection fraction may benefit from earlier intervention. We aim to validate the usefulness of a novel echo-marker, augmented mean arterial pressure (AugMAP), in identifying high-risk patients with moderate aortic stenosis. AugMAP can identify patients at higher mortality risk within the first two years after the diagnosis of moderate aortic stenosis, regardless of LVEF. AugMAP was also independently associated with all-cause mortality after adjusting for age, sex, and LVEF. AugMAP is a simple and effective novel echo-maker beyond LVEF to identify high-risk moderate aortic stenosis patients who may benefit from earlier intervention.