Publicação
Transcatheter Aortic Valve Implantation Outcomes in Patients with Low Flow Low Gradient Aortic Stenosis
| Resumo: | Background: Some studies suggest that patients with low flow low gradient (LF-LG) aortic stenosis (AS) may achieve worse results after undergoing transcatheter aortic valve implantation (TAVI). Purpose: To compare outcomes between LF-LG AS and high gradient (HG) AS patients submitted to TAVI. Methods: Inclusion of 480 consecutive patients who underwent TAVI between 2008 and 2020 at a single tertiary center. Patients were divided into high gradient AS and LF-LG AS; and baseline characteristics and outcomes after the procedure were collected and compared between groups. Results: Patients with LF-LG AS had worse baseline characteristics, with higher Society of Thoracic Surgeons score (p=0.008), New Euroscore II (p<0.0001), and NT pro-natriuretic peptide B (p=0.001), more frequent left ventricular ejection fraction (LVEF) <40% (p<0.0001), coronary artery disease (p<0.0001), including previous myocardial infarction (p=0.002) and coronary artery bypass graft (p<0.0001), poor vascular accesses (p=0.026) and periprocedural angioplasty (p=0.038). In a multivariate analysis, adjusted to differences in baseline characteristics, LF-LG AS was associated with worse functional class at one year (p=0.023) and in the long-term (p=0.004) and with heart failure hospitalizations at one year and in the long-term (p=0.001 and p<0.0001). In a sub-analysis including only patients with LF-LG AS, those with LVEF <40% had the worst outcomes, with more global (p=0.035) and cardiovascular (p=0.038) mortality. Conclusion: Patients with LF-LG AS have worse short and long-term outcomes, even when adjusted for baseline characteristic differences. The sub-group of patients with LVEF <40% have the most ominous global outcomes. |
|---|---|
| Autores principais: | Castelo, A |
| Outros Autores: | Grazina, A; Mendonça, T; Rodrigues, I; Garcia Brás, P; Ferreira, V; Ramos, R; Fiarresga, A; Cacela, D; Cruz Ferreira, R |
| Assunto: | HSM CAR Aortic Stenosis Low Flow Low Gradient Transcatheter Aortic Valve Implantation |
| Ano: | 2022 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Centro Hospitalar de Lisboa Central, EPE (CHLC) |
| Idioma: | inglês |
| Origem: | Repositório do Centro Hospitalar de Lisboa Central, EPE |
| _version_ | 1868412203556667392 |
|---|---|
| author | Castelo, A |
| author2 | Grazina, A Mendonça, T Rodrigues, I Garcia Brás, P Ferreira, V Ramos, R Fiarresga, A Cacela, D Cruz Ferreira, R |
| author2_role | author author author author author author author author author |
| author_facet | Castelo, A Grazina, A Mendonça, T Rodrigues, I Garcia Brás, P Ferreira, V Ramos, R Fiarresga, A Cacela, D Cruz Ferreira, R |
| author_role | author |
| contributor_name_str_mv | Repositório da Unidade Local de Saúde São José |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Castelo, A\"},{\"Person.name\":\"Grazina, A\"},{\"Person.name\":\"Mendonça, T\"},{\"Person.name\":\"Rodrigues, I\"},{\"Person.name\":\"Garcia Brás, P\"},{\"Person.name\":\"Ferreira, V\"},{\"Person.name\":\"Ramos, R\"},{\"Person.name\":\"Fiarresga, A\"},{\"Person.name\":\"Cacela, D\"},{\"Person.name\":\"Cruz Ferreira, R\"}] |
| datacite.contributors.contributor.contributorName.fl_str_mv | Repositório da Unidade Local de Saúde São José |
| datacite.creators.creator.creatorName.fl_str_mv | Castelo, A Grazina, A Mendonça, T Rodrigues, I Garcia Brás, P Ferreira, V Ramos, R Fiarresga, A Cacela, D Cruz Ferreira, R |
| datacite.date.Accepted.fl_str_mv | 2022-08-01T00:00:00Z |
| datacite.date.available.fl_str_mv | 2023-06-29T14:41:50Z |
| datacite.date.embargoed.fl_str_mv | 2023-06-29T14:41:50Z |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | HSM CAR Aortic Stenosis Low Flow Low Gradient Transcatheter Aortic Valve Implantation |
| datacite.titles.title.fl_str_mv | Transcatheter Aortic Valve Implantation Outcomes in Patients with Low Flow Low Gradient Aortic Stenosis Resultados da Implantação de Válvula Aórtica por Via Percutânea em Doentes com Estenose Aórtica com Baixo Fluxo-Baixo Gradiente |
| dc.contributor.none.fl_str_mv | Repositório da Unidade Local de Saúde São José |
| dc.creator.none.fl_str_mv | Castelo, A Grazina, A Mendonça, T Rodrigues, I Garcia Brás, P Ferreira, V Ramos, R Fiarresga, A Cacela, D Cruz Ferreira, R |
| dc.date.Accepted.fl_str_mv | 2022-08-01T00:00:00Z |
| dc.date.available.fl_str_mv | 2023-06-29T14:41:50Z |
| dc.date.embargoed.fl_str_mv | 2023-06-29T14:41:50Z |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | http://hdl.handle.net/10400.17/4580 |
| dc.language.none.fl_str_mv | eng |
| dc.publisher.none.fl_str_mv | Elsevier España |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.subject.none.fl_str_mv | HSM CAR Aortic Stenosis Low Flow Low Gradient Transcatheter Aortic Valve Implantation |
| dc.title.fl_str_mv | Transcatheter Aortic Valve Implantation Outcomes in Patients with Low Flow Low Gradient Aortic Stenosis Resultados da Implantação de Válvula Aórtica por Via Percutânea em Doentes com Estenose Aórtica com Baixo Fluxo-Baixo Gradiente |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | Background: Some studies suggest that patients with low flow low gradient (LF-LG) aortic stenosis (AS) may achieve worse results after undergoing transcatheter aortic valve implantation (TAVI). Purpose: To compare outcomes between LF-LG AS and high gradient (HG) AS patients submitted to TAVI. Methods: Inclusion of 480 consecutive patients who underwent TAVI between 2008 and 2020 at a single tertiary center. Patients were divided into high gradient AS and LF-LG AS; and baseline characteristics and outcomes after the procedure were collected and compared between groups. Results: Patients with LF-LG AS had worse baseline characteristics, with higher Society of Thoracic Surgeons score (p=0.008), New Euroscore II (p<0.0001), and NT pro-natriuretic peptide B (p=0.001), more frequent left ventricular ejection fraction (LVEF) <40% (p<0.0001), coronary artery disease (p<0.0001), including previous myocardial infarction (p=0.002) and coronary artery bypass graft (p<0.0001), poor vascular accesses (p=0.026) and periprocedural angioplasty (p=0.038). In a multivariate analysis, adjusted to differences in baseline characteristics, LF-LG AS was associated with worse functional class at one year (p=0.023) and in the long-term (p=0.004) and with heart failure hospitalizations at one year and in the long-term (p=0.001 and p<0.0001). In a sub-analysis including only patients with LF-LG AS, those with LVEF <40% had the worst outcomes, with more global (p=0.035) and cardiovascular (p=0.038) mortality. Conclusion: Patients with LF-LG AS have worse short and long-term outcomes, even when adjusted for baseline characteristic differences. The sub-group of patients with LVEF <40% have the most ominous global outcomes. |
| dirty | 0 |
| eu_rights_str_mv | openAccess |
| format | article |
| fulltext.url.fl_str_mv | https://repositorio.chlc.pt/bitstreams/eab93c02-0671-42d6-87d1-35a517ad4143/download |
| id | rchlc_cfe02ea727ebe4e4e1840866dc7cfd82 |
| identifier.url.fl_str_mv | http://hdl.handle.net/10400.17/4580 |
| instacron_str | chlc |
| institution | Centro Hospitalar de Lisboa Central, EPE (CHLC) |
| instname_str | Centro Hospitalar de Lisboa Central, EPE (CHLC) |
| language | eng |
| network_acronym_str | rchlc |
| network_name_str | Repositório do Centro Hospitalar de Lisboa Central, EPE |
| oai_identifier_str | oai:repositorio.chlc.pt:10400.17/4580 |
| organization_str_mv | urn:organizationAcronym:chlc |
| person_str_mv | Castelo, A Grazina, A Mendonça, T Rodrigues, I Garcia Brás, P Ferreira, V Ramos, R Fiarresga, A Cacela, D Cruz Ferreira, R |
| publishDate | 2022 |
| publisher.none.fl_str_mv | Elsevier España |
| reponame_str | Repositório do Centro Hospitalar de Lisboa Central, EPE |
| repository_id_str | urn:repositoryAcronym:rchlc |
| service_str_mv | urn:repositoryAcronym:rchlc |
| spelling | engElsevier Españapt_PTBackground: Some studies suggest that patients with low flow low gradient (LF-LG) aortic stenosis (AS) may achieve worse results after undergoing transcatheter aortic valve implantation (TAVI). Purpose: To compare outcomes between LF-LG AS and high gradient (HG) AS patients submitted to TAVI. Methods: Inclusion of 480 consecutive patients who underwent TAVI between 2008 and 2020 at a single tertiary center. Patients were divided into high gradient AS and LF-LG AS; and baseline characteristics and outcomes after the procedure were collected and compared between groups. Results: Patients with LF-LG AS had worse baseline characteristics, with higher Society of Thoracic Surgeons score (p=0.008), New Euroscore II (p<0.0001), and NT pro-natriuretic peptide B (p=0.001), more frequent left ventricular ejection fraction (LVEF) <40% (p<0.0001), coronary artery disease (p<0.0001), including previous myocardial infarction (p=0.002) and coronary artery bypass graft (p<0.0001), poor vascular accesses (p=0.026) and periprocedural angioplasty (p=0.038). In a multivariate analysis, adjusted to differences in baseline characteristics, LF-LG AS was associated with worse functional class at one year (p=0.023) and in the long-term (p=0.004) and with heart failure hospitalizations at one year and in the long-term (p=0.001 and p<0.0001). In a sub-analysis including only patients with LF-LG AS, those with LVEF <40% had the worst outcomes, with more global (p=0.035) and cardiovascular (p=0.038) mortality. Conclusion: Patients with LF-LG AS have worse short and long-term outcomes, even when adjusted for baseline characteristic differences. The sub-group of patients with LVEF <40% have the most ominous global outcomes.application/pdfpt_PTTranscatheter Aortic Valve Implantation Outcomes in Patients with Low Flow Low Gradient Aortic StenosisAlternativeTitlept_PTResultados da Implantação de Válvula Aórtica por Via Percutânea em Doentes com Estenose Aórtica com Baixo Fluxo-Baixo GradienteCastelo, AGrazina, AMendonça, TRodrigues, IGarcia Brás, PFerreira, VRamos, RFiarresga, ACacela, DCruz Ferreira, RHostingInstitutionOrganizationalRepositório da Unidade Local de Saúde São Josée-mailmailto:repositorio@ulssjose.min-saude.ptrepositorio@ulssjose.min-saude.ptDOIIsPartOf10.1016/j.repc.2022.03.0022023-06-29T14:41:50Z2022-082022-08-01T00:00:00ZHandlehttp://hdl.handle.net/10400.17/4580http://purl.org/coar/access_right/c_abf2open accessHSM CARAortic StenosisLow Flow Low GradientTranscatheter Aortic Valve Implantation1155354 bytesliteraturehttp://purl.org/coar/resource_type/c_6501journal articlehttp://purl.org/coar/access_right/c_abf2application/pdffulltexthttps://repositorio.chlc.pt/bitstreams/eab93c02-0671-42d6-87d1-35a517ad4143/downloadRevista Portuguesa de Cardiologia418621631 |
| spellingShingle | Transcatheter Aortic Valve Implantation Outcomes in Patients with Low Flow Low Gradient Aortic Stenosis Castelo, A HSM CAR Aortic Stenosis Low Flow Low Gradient Transcatheter Aortic Valve Implantation |
| status | SINGLETON |
| subject.fl_str_mv | HSM CAR Aortic Stenosis Low Flow Low Gradient Transcatheter Aortic Valve Implantation |
| title | Transcatheter Aortic Valve Implantation Outcomes in Patients with Low Flow Low Gradient Aortic Stenosis |
| title_full | Transcatheter Aortic Valve Implantation Outcomes in Patients with Low Flow Low Gradient Aortic Stenosis |
| title_fullStr | Transcatheter Aortic Valve Implantation Outcomes in Patients with Low Flow Low Gradient Aortic Stenosis |
| title_full_unstemmed | Transcatheter Aortic Valve Implantation Outcomes in Patients with Low Flow Low Gradient Aortic Stenosis |
| title_short | Transcatheter Aortic Valve Implantation Outcomes in Patients with Low Flow Low Gradient Aortic Stenosis |
| title_sort | Transcatheter Aortic Valve Implantation Outcomes in Patients with Low Flow Low Gradient Aortic Stenosis |
| topic | HSM CAR Aortic Stenosis Low Flow Low Gradient Transcatheter Aortic Valve Implantation |
| topic_facet | HSM CAR Aortic Stenosis Low Flow Low Gradient Transcatheter Aortic Valve Implantation |
| url | http://hdl.handle.net/10400.17/4580 |
| visible | 1 |