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Prognostic Relevance of Left Ventricular Myocardial Performance After Transcatheter Aortic Valve Replacement
Masahiko Asami1, Thomas Pilgrim1, Jonas Lanz1
1Department of Cardiology (M.A., T.P., J.L., A.F., R.P., F.P., L.R., M.V., S.W., S.S.).
Insights
The Tei index, a measure of heart function, predicts mortality after transcatheter aortic valve replacement (TAVR). Both pre- and post-TAVR Tei index values are linked to increased risks of death in patients with severe aortic stenosis.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Surgery
Background:
- The Tei index is an echocardiographic parameter assessing left-ventricular systolic and diastolic function.
- Prognostic value of cardiac parameters post-transcatheter aortic valve replacement (TAVR) is known, but Tei index role is unevaluated.
- Severe aortic stenosis necessitates TAVR, a procedure with established outcomes but requiring further prognostic markers.
Purpose of the Study:
- To evaluate the prognostic role of the Tei index in patients undergoing TAVR.
- To determine if pre- and post-TAVR Tei index values predict mortality.
- To assess Tei index as an independent predictor of early and late mortality post-TAVR.
Main Methods:
- Retrospective analysis of 824 patients with symptomatic severe aortic stenosis undergoing TAVR.
- Echocardiography performed pre- and post-TAVR to calculate the Tei index.
- Primary endpoint: all-cause mortality at 1 year; secondary: mortality at 30 days and between 30 days and 1 year.
Main Results:
- High pre-TAVR Tei index (≥0.45) was associated with increased 30-day (aHR 3.62) and 1-year mortality (aHR 2.56).
- High post-TAVR Tei index (≥0.45) was linked to increased mortality between 30 days and 1 year (aHR 6.70).
- Multivariable analysis identified Tei index as an independent predictor of both early and late mortality post-TAVR.
Conclusions:
- The Tei index is a significant predictor of outcomes following TAVR.
- Elevated Tei index values, both before and after the procedure, indicate higher mortality risk.
- Tei index can be utilized as a valuable tool for risk stratification in TAVR patients.
Background:
The left-ventricular myocardial performance index Tei is an echocardiographic parameter that incorporates the information of systolic and diastolic time intervals. While the prognostic value of selected systolic and diastolic parameters is well established after transcatheter aortic valve replacement, the role of Tei has not been evaluated in this setting.
Methods And Results:
Between August 2007 and December 2015, consecutive patients with symptomatic, severe aortic stenosis and transthoracic echocardiography pre- and post-transcatheter aortic valve replacement were considered eligible for this analysis. The primary end point was all-cause mortality at 1 year after transcatheter aortic valve replacement. Of 824 patients with echocardiographic images to calculate Tei, pre-Tei was normal (<0.45) in 639 and high (≥0.45) in 185, whereas post-Tei was normal in 602 and high in 120, respectively. After adjustment for confounding factors, high pre-Tei was associated with an increased risk of all-cause mortality at 30 days (adjusted hazard ratio [HRadj] 3.62; 95% CI, 1.89-6.91) and 1 year (HRadj 2.56; 95% CI, 1.78-3.69). Similarly, post-Tei was associated with an increased risk of mortality between 30 days and 1-year follow-up (HRadj 6.70; 95% CI, 4.22-10.63). At multivariable analysis Tei emerged as an independent predictor of early (pre-Tei index per 0.1-HRadj 1.40; 95% CI, 1.23-1.60) and late mortality (post-Tei index per 0.1-HRadj 1.40; 95% CI, 1.31-1.50), respectively.
Conclusions:
The left-ventricular myocardial performance index Tei is associated with impaired clinical outcomes during short- and longer-term follow-up after transcatheter aortic valve replacement.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov . Unique identifier: NCT01368250.
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