Predictors of In-Hospital Mortality after Transcatheter Aortic Valve Implantation

Krittanawong, Chayakrit; Kumar, Anirudh; Wang, Zhen; Johnson, Kipp W.; Rastogi, Ujjwal; Narasimhan, Bharat; Kaplin, Scott; Virk, Hafeez Ul Hassan; Baber, Usman; Tang, W.H. Wilson; Lansky, Alexandra J.; Stone, Gregg W.

doi:10.1016/j.amjcard.2019.10.014

Cited by 9 publications

(8 citation statements)

References 30 publications

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“…The coexistence of severe AS and HFpEF is a common, yet underrecognized phenomenon. In a recent analysis of the US National Inpatient Sample registry, 37.0% of all patients receiving TAVI for severe AS and 67.4% of those with known heart failure were diagnosed with HFpEF 26 . In the present study, we investigated characteristics and outcomes of this subset of patients with AS and concomitant HFpEF as diagnosed by the H 2 FPEF score.…”

Section: Discussionmentioning

confidence: 95%

“…In a recent analysis of the US National Inpatient Sample registry, 37.0% of all patients receiving TAVI for severe AS and 67.4% of those with known heart failure were diagnosed with HFpEF. 26 In the present study, we investigated characteristics and outcomes of this subset of patients with AS and concomitant HFpEF as diagnosed by the H 2 FPEF score. Compared with patients with HFrEF, patients with HFpEF are usually older, more commonly female, more likely to be hypertensive, and less likely to suffer from coronary artery disease.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic value of the H₂FPEF score in patients undergoing transcatheter aortic valve implantation

Ludwig¹,

Pellegrini

Goßling³

et al. 2020

ESC Heart Failure

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Aims The aim of this study was to assess the prognostic value of the H2FPEF score in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) and preserved left ventricular ejection fraction (EF). Methods and results In this multicentre study, a total of 832 patients from two German high‐volume centres, who received TAVI for severe AS and preserved EF (≥50%), were identified for calculation of the H2FPEF score. Patients were dichotomized according to low (0–5 points; n = 570) and high (6–9 points; n = 262) H2FPEF scores. Kaplan–Meier and Cox regression analyses were applied to assess the prognostic impact of the H2FPEF score. We observed a decrease in stroke volume index (−2.04 mL/m2/point) and mean transvalvular gradients (−1.14 mmHg/point) with increasing H2FPEF score translating into a higher prevalence of paradoxical low‐flow, low‐gradient AS among patients with high H2FPEF score. One year after TAVI, the rates of all‐cause (low vs. high H2FPEF score: 8.0% vs. 19.4%, P < 0.0001) and cardiovascular (CV) mortality (1.9% vs. 9.0%, P < 0.0001) as well as the rate of CV mortality or rehospitalization for congestive heart failure (6.4% vs. 23.2%, P < 0.0001) were higher in patients with high H2FPEF score compared with those with low H2FPEF score. After multivariable analysis, a high H2FPEF score remained independently predictive of all‐cause mortality [hazard ratio 1.59 (1.28–2.35), P = 0.018] and CV mortality or rehospitalization for congestive heart failure [hazard ratio 2.92 (1.65–5.15), P < 0.001]. Among the H2FPEF score variables, atrial fibrillation, pulmonary hypertension, and elevated left ventricular filling pressure were the strongest outcome predictors. Conclusions The H2FPEF score serves as an independent predictor of adverse CV and heart failure outcome among TAVI patients with preserved EF. A high H2FPEF score is associated with the presence of paradoxical low‐flow, low‐gradient AS, the HFpEF in patients with AS. By identifying patients in advanced stages of HFpEF, the H2FPEF score might be useful as a risk prediction tool in patients with preserved EF scheduled for TAVI.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Prognostic value of the H₂FPEF score in patients undergoing transcatheter aortic valve implantation

Ludwig¹,

Pellegrini

Goßling³

et al. 2020

ESC Heart Failure

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“…Some studies have found that among TAVI patients with severe AS, in-hospital mortality rates were similar in those with HFpEF and those with heart failure with a reduced ejection fraction, while others have found a better prognosis at 1 year in those with HFpEF compared with those with reduced ejection fraction. 25,26 Notably, in patients with HFpEF, treating moderate AS may be beneficial, due to the fact that AS is a modifiable driver of diastolic dysfunction. AS causes increased left ventricular afterload, which leads to left ventricular hypertrophy and results in diastolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

HFA‐PEFF score: prognosis in patients with preserved ejection fraction after transcatheter aortic valve implantation

et al. 2022

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Aims Many transcatheter aortic valve implantation (TAVI) candidates have underlying heart failure with preserved ejection fraction (HFpEF) in addition to symptomatic aortic stenosis. Diagnosis of HFpEF is challenging. The Heart Failure Association of the European Society of Cardiology proposed the HFA-PEFF score as part of a novel diagnostic algorithm. This study assessed the prognostic value of the HFA-PEFF score in patients with preserved ejection fraction after TAVI. Methods and resultsThis single-centre study included 570 consecutive TAVI patients with a preserved left ventricular ejection fraction of ≥50%. Patients with an HFA-PEFF score of ≥5 [n = 239 (41.9%)] were compared with those with <5 points [n = 331 (58.1%)]. The primary outcome was a composite of all-cause mortality or first heart failure rehospitalization within 1 year after TAVI. Secondary endpoints were the individual components of the primary outcome. Patients with an HFA-PEFF score ≥ 5 had higher rates of comorbidities commonly associated with HFpEF, a higher rate of new pacemaker implantation after TAVI, were at increased risk of the primary composite endpoint (25.5% vs. 10.0%, P < 0.001), and rehospitalization for heart failure (11.7% vs. 3.9%, P < 0.001). Multivariable analysis confirmed an HFA-PEFF score ≥ 5 as an independent risk factor for the composite endpoint [hazard ratio 2.70, 95% confidence interval (CI) 1.70-4.28, P < 0.001] and for all-cause mortality (hazard ratio 2.58, 95% CI 1.46-4.53, P = 0.001). ConclusionThe HFA-PEFF score is associated with all-cause mortality and heart failure rehospitalization in patients with preserved ejection fraction after TAVI. This practical tool can easily be incorporated into risk stratification algorithms for TAVI patients.

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“…More than half of heart failure patients undergoing TAVI are diagnosed with HFpEF and experience similar rehospitalisation and mortality rates when compared with other subsets of heart failure [10]. Yet, they could be misdiagnosed, and their management might be delayed [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of HFA-PEFF Score in Patients Undergoing Transcatheter Aortic Valve Implantation

Al-Otaibi¹,

Elbasha²,

Landt³

et al. 2022

Cureus

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BackgroundThe HFA-PEFF score may help in predicting long-term outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis and preserved left ventricular ejection fraction (EF). MethodsWe retrieved data from 1,332 patients undergoing TAVI between 2010 and 2019 from the Prospective Segeberg TAVI Registry (ClinicalTrials.gov Identifier: NCT03192774). We calculated the HFA-PEFF score for 1,022 patients who had preserved EF (≥50%). To assess the prognostic value of the HFA-PEFF score in predicting adverse events, we dichotomised the patients according to a cut-off score of five (score <5 group: n=528 (51.6%), score ≥5 group: n=494 (48.3%)). ResultsThe HFA-PEFF score ≥5 groups were older (81.9±6.3 years vs. 80.3±6.9 years; p<0.001) and had a higher prevalence of atrial fibrillation (35.1% vs 20.8%; p<0.001) and chronic kidney disease (30.1% vs 26.1%; p<0.001). Kaplan-Meier survival analyses over 24 months showed increased cardiovascular (CV) mortality (12.5% vs. 7.7%, log-rank; p=0.028) and first heart failure-related rehospitalisation (7.7% vs. 4.0%, log-rank p=0.014) in the HFA-PEFF score ≥5 groups compared with those of lower scores. No significant difference in all-cause mortality between both groups was observed (22.0% vs. 17.9%, log-rank p=0.127). In multivariate analysis, HFA-PEFF score ≥5 failed to predict CV mortality (aHR 1.37, 95% CI: 0.90-2.08, p=0.140) and time to first heart failure-related rehospitalisation (aHR 1.49, 95% CI: 0.83-2.65, p=0.181). ConclusionThe HFA-PEFF score showed limited value in predicting long-term mortality and adverse heart failurerelated events in patients with preserved EF undergoing TAVI. Clinical variables specific to this population could complement the HFA-PEFF score for better risk prediction.

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Predictors of In-Hospital Mortality after Transcatheter Aortic Valve Implantation

Cited by 9 publications

References 30 publications

Prognostic value of the H₂FPEF score in patients undergoing transcatheter aortic valve implantation

Prognostic value of the H₂FPEF score in patients undergoing transcatheter aortic valve implantation

HFA‐PEFF score: prognosis in patients with preserved ejection fraction after transcatheter aortic valve implantation

Prognostic Value of HFA-PEFF Score in Patients Undergoing Transcatheter Aortic Valve Implantation

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Predictors of In-Hospital Mortality after Transcatheter Aortic Valve Implantation

Cited by 9 publications

References 30 publications

Prognostic value of the H2FPEF score in patients undergoing transcatheter aortic valve implantation

Prognostic value of the H2FPEF score in patients undergoing transcatheter aortic valve implantation

HFA‐PEFF score: prognosis in patients with preserved ejection fraction after transcatheter aortic valve implantation

Prognostic Value of HFA-PEFF Score in Patients Undergoing Transcatheter Aortic Valve Implantation

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Prognostic value of the H₂FPEF score in patients undergoing transcatheter aortic valve implantation

Prognostic value of the H₂FPEF score in patients undergoing transcatheter aortic valve implantation