A novel echo-parameter supersedes the Society of Thoracic Surgeons risk score in predicting post transcatheter aortic valve replacement mortality

Abstract

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.

Using a novel echo-marker to identify high mortality risk patients with moderate aortic stenosis

“…Foreseeing the possibility of an expanded indication for aortic valve placement in patients with moderate AS, it is essential to determine the optimal timing of intervention and predict post-procedure outcomes in this population. Our group previously identified a new parameter, augmented mean arterial pressure (AugMAP), which supersedes the performance in predicting 1-year mortality after TAVR(6). AugMAP is derived from noninvasive blood pressure measurements and mean aortic valve gradient determined by continuous-wave Doppler, as a surrogate marker of cardiac contractile reserve in patients with aortic stenosis.…”