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Determinants of one-year outcome from balloon aortic valvuloplasty
C J Davidson1, J K Harrison, K S Pieper
1Duke University Medical Center, Department of Medicine, Durham, North Carolina 27710.
Insights
Predicting long-term outcomes after balloon aortic valvuloplasty (BAV) is crucial. Baseline left ventricular ejection fraction is a key predictor of cardiac death, offering valuable insights for severe aortic stenosis management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Echocardiography
Background:
- Balloon aortic valvuloplasty (BAV) is an alternative for severe symptomatic aortic stenosis.
- Previous outcome prediction models lacked comprehensive data.
- Accurate long-term prognostication remains a challenge.
Purpose of the Study:
- To predict long-term outcomes following BAV.
- To identify predictors of major adverse events and cardiac death.
- To evaluate the utility of comprehensive clinical and hemodynamic data.
Main Methods:
- Prospective collection of clinical, hemodynamic, ventriculographic, and echocardiographic data.
- Data gathered at baseline, immediately post-procedure, and at 3 and 6 months.
- Cox model analysis used to identify predictors of 1-year major events.
Main Results:
- Advanced age, heart failure class, and diastolic LV diameter predicted major events.
- Baseline left ventricular ejection fraction was the sole significant predictor of cardiac death (p=0.002).
- Post-procedure ejection fraction, valve area, and gradients did not improve prediction beyond baseline LVEF.
Conclusions:
- Baseline left ventricular ejection fraction is a critical independent predictor of cardiac death post-BAV.
- Comprehensive hemodynamic and echocardiographic data acquired acutely or at 3 months do not enhance prognostic accuracy beyond LVEF.
- A baseline ejection fraction >= 45% was associated with 80% 1-year cardiac survival.
Abstract:
Balloon aortic valvuloplasty (BAV) has been a therapeutic alternative treatment for severe symptomatic aortic stenosis. Previous studies have been unable to predict 1-year outcome because of limited acute and follow-up clinical, invasive and echocardiographic data. The purpose of this study was to predict long-term outcome based on comprehensive data obtained at the time of valvuloplasty and at 3 and 6 months after the procedure. Of 170 consecutive patients undergoing BAV, 108 (mean age 78 years) were at least 1 year from their procedure. Prospective clinical, micromanometer hemodynamic, digital ventriculographic and echocardiographic/Doppler data were collected at baseline and immediately after the procedure. Echocardiographic data were also obtained at 3 and 6 months. With use of Cox model analysis, major events (defined as cardiac death [n = 30], aortic valve replacement [n = 21] or repeat BAV [n = 13]) were predicted by advanced age, baseline heart failure class, and baseline echocardiographic-determined diastolic left ventricular diameter. Only baseline left ventricular ejection fraction proved to be a significant predictor of cardiac death (p = 0.002) in a multivariate model. Absolute values after BAV (stroke work, first derivative of left ventricular pressure, valve area, end-systolic volume, Fick cardiac output, transvalvular gradient) and acute changes measured by catheterization or echocardiography did not provide additional predictive information over that of post procedure ejection fraction. Similarly, echocardiographic valve area and transvalvular gradient at 3 months added no further prognostic data. With an ejection fraction greater than or equal to 45% (n = 63), cardiac survival at 1 year was 80%, irrespective of age, sex, congestive heart failure class or severity of coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)