Does a Gradient-Adjusted Cardiac Power Index Improve Prediction of Post-Transcatheter Aortic Valve Replacement Survival Over Cardiac Power Index?

Agasthi, Pradyumna; Pujari, Sai Harika; Mookadam, Farouk; Tseng, Andrew; Venepally, Nithin R; Wang, Panwen; Allam, Mohamed; Sweeney, John P.; Eleid, Mackram F.; Fortuin, F. David; Holmes, David R.; Beohar, Nirat; Arsanjani, Reza

doi:10.3349/ymj.2020.61.6.482

Cited by 5 publications

(11 citation statements)

References 34 publications

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“…When calculating the augmented blood pressure, we assumed that adding the mean aortic valve gradient to the systemic systolic blood pressure can reflect the actual systolic pressure generated by the left ventricle (12). While noninvasive MAP is practically calculated as the summation of diastolic blood pressure and 1/3 pulse pressure, MAP also equals the product of cardiac output and systemic vascular resistance (SVR) (assuming a negligible central venous pressure level).…”

Section: Discussionmentioning

confidence: 99%

“…The augmented blood pressure calculation formulas are stated as below (12): Augmented SBP1(AugSBP1): Mean aortic valve gradient (mean AVG) was added to systolic blood pressure (Equation 1) and augmented MAP1(AugMAP1) was calculated by replacing the SBP with augmented SBP1 in the MAP formula (Equation 2); Valvulo-arterial impedance (Zva) was calculated according to the standard formula by dividing the sum of the systolic blood pressure and mean transvalvular gradient by stroke volume index (SVI)(Equation 3)(13).…”

Section: Calculation Of Augmented Mean Arterial Pressure and Valvulo-arterial Impedancementioning

confidence: 99%

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

Chao

Agasthi

Barry

et al. 2021

Preprint

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Calculation Of Augmented Mean Arterial Pressure and Valvulo-arterial Impedancementioning

confidence: 99%

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

Chao

Agasthi

Barry

et al. 2021

Preprint

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“…Elevated Zva has been reported to be associated with worse quality of life and exercise performance at one year (10), while there are inconsistent results in predicting long-term mortality (14)(15)(16). Our group previously reported that cardiac power index and gradient-adjusted cardiac power index are good predictors of 1-year mortality after TAVR (6,7). In the calculation of gradient-adjusted cardiac power index, transvalvular gradient (mean transvalvular gradient or instantaneous peak transvalvular gradient) was added to the systolic blood pressure as augmented systolic blood pressure to calculate augmented mean arterial pressure (MAP).…”

Section: Background/introductionmentioning

confidence: 88%

“…2) Augmented SBP2(AugSBP2): Aortic valve maximal instantaneous gradient was added to systolic blood pressure (Equation 2), and augmented MAP2(AugMAP2) was calculated by replacing the SBP with augmented SBP2(Equation 4); and 3) Augmented MAP3(AugMAP3): Aortic valve mean gradient was added to mean arterial pressure (Equation 5) (6). Valvulo-arterial impedance (Zva) was calculated according to the standard formula by dividing the sum of the systolic blood pressure and mean transvalvular gradient by stroke volume index (SVI) (15).…”

Section: Calculation Of Augmented Systolic Blood Pressure Mean Arterial Pressure and Valvulo-arterial Impedancementioning

confidence: 99%

“…Given the underlying comorbidities, the clinical outcomes after TAVR procedure have gained significant attention that involves both conventional and machine learning research approaches (5)(6)(7)(8)(9)(10)(11)(12). There are newer studies focused on the relationship of blood pressure and valvuloarterial impedance (Zva), which estimates the overall left ventricular afterload, and its effect on TAVR prognosis (8)(9)(10)13).…”

Section: Background/introductionmentioning

confidence: 99%

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

Chao

Agasthi

Seri

et al. 2021

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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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Using Augmented Mean Arterial Pressure to Identify High Mortality Risk Patients With Moderate Aortic Stenosis

Chao,

Agasthi,

Girardo

et al. 2023

Mayo Clinic Proceedings

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Does a Gradient-Adjusted Cardiac Power Index Improve Prediction of Post-Transcatheter Aortic Valve Replacement Survival Over Cardiac Power Index?

Cited by 5 publications

References 34 publications

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

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

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

Using Augmented Mean Arterial Pressure to Identify High Mortality Risk Patients With Moderate Aortic Stenosis

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