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Risk Prediction in Aortic Valve Replacement: Incremental Value of the Preoperative Echocardiogram

Timothy C Tan1, Aidan W Flynn2, Annabel Chen-Tournoux3

  • 1Massachusetts General Hospital, Harvard Medical School, Boston, MA (T.C.T., A.W.F., P.M., M.C.N., L.M.R., D.M.S., M.H.P., J.A.).

Journal of the American Heart Association
|October 28, 2015
PubMed

Insights

Echocardiograms can improve risk prediction for aortic valve replacement (AVR) surgery. Key echocardiographic measures, including left ventricular filling pressure and right ventricular function, enhance existing risk scores for better patient selection.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Risk prediction is crucial for selecting patients for aortic valve replacement (AVR).
  • Current risk scores utilize limited echocardiographic parameters.
  • There is a need to assess the added value of comprehensive echocardiography in identifying high-risk surgical candidates.

Purpose of the Study:

  • To evaluate the incremental predictive value of a complete echocardiogram.
  • To identify high-risk surgical candidates before AVR.
  • To improve patient selection for AVR.

Main Methods:

  • A cohort of 432 patients undergoing surgical AVR for severe aortic stenosis was studied.
  • Preoperative echocardiograms were analyzed for chamber size/function and valve function.
  • Multivariable logistic regression and Cox regression were used to identify predictors of mortality and morbidity.

Main Results:

  • E/e' ratio, myocardial performance index, and small left ventricular (LV) end-diastolic cavity size predicted in-hospital mortality or major morbidity.
  • These echocardiographic parameters improved risk prediction by 4.1% when added to the STS risk score.
  • Small LV end-diastolic cavity size, LV mass index, mitral regurgitation grade, right atrial area index, and mean aortic gradient <40 mm Hg predicted 2-year all-cause mortality.

Conclusions:

  • Echocardiographic measures of LV diastolic dysfunction and RV performance offer incremental value to the STS risk score.
  • These echocardiographic findings should be integrated into risk prediction for AVR.
  • Small, hypertrophied LV cavities and low mean aortic gradients are associated with higher 2-year mortality risk.
Abstract

Keywords:
aortic stenosisaortic valve replacementechocardiographyoutcomes

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