Preprocedural Prognostic Factors in Acute Decompensated Aortic Stenosis

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Imaging

Background:

• Acute decompensated aortic stenosis (ADAS) is a critical condition with significant mortality.
• Myocardial remodeling and function, assessed by echo staging, influence outcomes in stable aortic stenosis but remain understudied in ADAS.
• Understanding predictors of mortality in ADAS is crucial for patient management.

Purpose of the Study:

• To investigate the impact of myocardial characteristics, echocardiographic staging, and clinical parameters on mortality in patients with ADAS undergoing transcatheter aortic valve implantation (TAVI).

Main Methods:

• Retrospective observational study of 292 consecutive ADAS patients who underwent TAVI.
• Evaluation of echocardiographic and clinical characteristics using regression analysis.
• Assessment of all-cause mortality as the primary outcome post-TAVI.

Main Results:

• Advanced echocardiographic staging (grade >2) independently predicted mortality at 1 year post-TAVI (HR 1.85, p=0.045).
• Frailty independently predicted mid-term mortality (2.4 ± 1.4 years follow-up) (HR 2.31, p=0.001).
• Myocardial, valvular, and other clinical parameters did not predict mid-term mortality.

Conclusions:

• In ADAS patients undergoing TAVI, echocardiographic staging is a significant predictor of short-term mortality.
• Frailty emerges as the primary driver of mid-term mortality in this patient cohort.
• These findings highlight distinct predictors for short-term versus mid-term outcomes in ADAS post-TAVI.