Left ventricular end‐diastolic pressure as an independent predictor of outcome during balloon aortic valvuloplasty

Abstract

Objectives In this study, we examined the predictive value of the left ventricular enddiastolic pressure (LVEDP) in patients undergoing balloon aortic valvuloplasty (BAV). Background The LVEDP is a useful indicator of hemodynamic status in patients with severe aortic stenosis. In BAV, decompensated heart failure is associated with worse outcomes. Methods We identified all consecutive patients with severe symptomatic aortic stenosis who underwent retrograde BAV at the Massachusetts General Hospital from 2004 to 2008. Patients were stratified and compared according to their baseline LVEDP into ≤15 mm Hg, 16–20 mm Hg, 21–25 mm Hg, and ≥26 mm Hg. Procedural and in-hospital outcomes and adverse events were compared. Multivariate logistic regression was used for the adjusted analysis. Results A total of 111 patients with a mean age of 83±11 years underwent BAV. Of these, the LVEDP was ≤15 mm Hg in 29 (26%), 16–20 mm Hg in 41 (37%), 21–25 mm Hg in 16 (14%), and ≥26 mm Hg in 25 (23%) patients. Baseline characteristics were similar among the four groups. Noticeably, patients with high LVEDP levels had significantly higher rates of the combined endpoint of in-hospital death, myocardial infarction (MI), cardiopulmonary arrest, and tamponade was P = 0.02. Periprocedural MI was more common among those with higher LVEDP (16% vs. 2.3%; P = 0.04). Multivariate analysis revealed LVEDP (OR 1.08, for each mm Hg increase in pressure, 95 % CI 1.02–1.14), small LV chamber size, and New York Heart Association class as independent predictors of adverse outcomes. Conclusions The LVEDP is an important independent predictor of poor in-hospital outcome during BAV. In these patients, the immediate hemodynamic status may be more important than the baseline left ventricular systolic function. Hemodynamic optimization before or during BAV should be considered and may be beneficial.

Long-term results of percutaneous balloon valvuloplasty of congenital aortic stenosis in adolescents and young adults

“…So although the need of repeated BAV correlated with the ventricular dysfunction, statistically it did not impact the difference in long-term outcome when compared for all the three groups ( p value = 0.751 for patients undergoing repeat BAV with and without LV dysfunction). Also, in consistent with the observed studies, the ventricular dysfunction improved significantly in all the age groups after BAV 15 . Pedersen et al have demonstrated the same even in the elderly population 16, 17.…”

“…Significant decrease in gradients have been shown by many other studies 4, 5, 6, 7, 8, 10, 11. Similarly, as others,4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 we have obtained an effective reduction of gradient by valvuloplasty but the gradient on average did not increase over the follow-up period. In our study, there was a statistically significant reduction in gradient in each of the three subgroups but there was no statistical difference between the change in gradients between the three groups of patients A, B, and C and hence the BAV procedure is equally efficacious in all the three with no statistical difference between the subgroups.…”

“…Our restenosis rate was comparable and aortic insufficiency rate and surgical rate were lower than many other reported studies 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20. O Reich et al 4 followed up over a period of 15 years showed restenosis rate of 16.7% ( n = 45) and significant insufficiency in 22.3% ( n = 60); surgery was needed in 20.1% ( n = 54), and “valvuloplasty failure” occurred in 41.6% ( n = 112) of patients.…”

Targeting elevated left ventricular end-diastolic pressure following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction – a phase one safety and feasibility study

“…Patients undergoing balloon aortic valvuloplasty and coronary artery bypass grafting with LVEDP above the median had worse outcomes, suggesting that a strategy of LVEDP lowering may have the potential to help other high-risk cardiovascular patients. 14,15 SBP/LVEDP ratio and CPP have been shown to be responsible for adverse left ventricular remodelling in patients with coronary artery disease. 16,17 Given the small sample size and short treatment duration no significant difference in peak troponin level (as a surrogate for infarct size) has been demonstrated in our cohort.…”

“…Patients undergoing balloon aortic valvuloplasty and coronary artery bypass grafting with LVEDP above the median had worse outcomes, suggesting that a strategy of LVEDP lowering may have the potential to help other high-risk cardiovascular patients. 14,15…”