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Updated: Jul 25, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Echocardiographic Derived Parameters Association With Long-Term Outcomes After Transcatheter Valve Replacement
Mohammad Al-Akchar1, Khalid Sawalha2, Hadi Mahmaljy3
1Division of Cardiology, Department of Internal Medicine, SIU School of Medicine, United States of America.
Insights
Low left ventricular ejection fraction (LVEF) below 35% is the strongest predictor of 1-year mortality after Transcatheter Aortic Valve Replacement (TAVR) for severe aortic stenosis. Other echocardiographic measures did not show significant predictive value.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Severe aortic stenosis (AS) management relies on echocardiographic parameters like flow, velocity, gradient, and ejection fraction.
- The prognostic value of these echocardiographic measures in patients undergoing Transcatheter Aortic Valve Replacement (TAVR) for severe AS requires further clarification.
Purpose of the Study:
- To evaluate the predictive significance of echocardiography-derived parameters for 1-year mortality in patients with severe AS undergoing TAVR.
- To identify key echocardiographic determinants of prognosis following TAVR.
Main Methods:
- A retrospective analysis of severe AS patients who underwent TAVR between January 2012 and June 2016.
- Hierarchical logistic regression analysis was employed to identify predictors of 1-year mortality.
- Patients were categorized based on stroke volume index (SVI) for flow (Normal Flow ≥35 ml/m², Low Flow <35 ml/m²) and mean gradient (MG) for pressure (High Gradient ≥40 mmHg, Low Gradient <40 mmHg).
Main Results:
- A total of 399 patients were analyzed, with no significant differences in baseline characteristics.
- Left ventricular ejection fraction (LVEF) <35% was significantly associated with higher 1-year mortality (17.6% vs. 8.9%, RR=2.19, P=0.03).
- No significant differences in 1-year mortality were observed concerning Mean Gradient (MG), transaortic flow/Stroke Volume Index (SVI), Dimensional Index (DI), V max, or Aortic Valve Area (AVA).
Conclusions:
- Low left ventricular ejection fraction (LVEF) <35% is the most robust predictor of 1-year mortality after TAVR in patients with severe aortic stenosis.
- Echocardiographic parameters such as MG, SVI, DI, V max, and AVA do not appear to be significant predictors of 1-year mortality in this cohort.
Background:
Transaortic flow, maximum velocity (V max), mean gradient (MG), left ventricular ejection fraction (LVEF), Aortic valve area (AVA) and dimensional index (DI) are important determinants of prognosis in patients with severe aortic stenosis. The specific role of these echocardiography-derived values in predicting prognosis of severe aortic stenosis patients undergoing Transcatheter aortic valve replacement (TAVR) is less defined.
Methods:
We identified all severe AS patients who underwent TAVR between 01/2012 and 6/2016. Baseline characteristics, clinical, procedural and one year follow-up data were obtained. Hierarchical logistic regression was used to assess predictors of 1-year mortality after TAVR. Normal flow (NF) was defined as having stroke volume index (SVI) of ≥35 ml/m2; while low Flow (LF) was defined as SVI < 35 ml/m2. High gradient (HG) was defined as mean gradient of ≥40 mmHg; while low gradient (LG) was defined as <40 mmHg.
Results:
A total of 399 patients were analyzed. There were no significant differences in baseline characteristics. LVEF less than 35% was associated with higher rate of 1-year mortality (17.6% LVEF <35% vs. 8.9% LVEF≥35%; RR = 2.19; CI 1.05 to 4.54; P = 0.03). There was no difference in 1-year mortality outcomes after TAVR in relation to: Mean Gradient MG, transaortic flow/Stroke Volume Index SVI, DI, V max or AVA.
Conclusion:
Low LVEF <35% remains the strongest parameter associated with 1 year mortality after TAVR.
