Transcatheter Aortic Valve Replacement Prognostication with Augmented Mean Arterial Pressure

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Assessing patient outcomes after transcatheter aortic valve replacement (TAVR) is crucial.
• New echocardiographic parameters, augmented systolic blood pressure (AugSBP) and augmented mean arterial pressure (AugMAP), were developed using blood pressure and aortic valve gradients.

Purpose of the Study:

• To evaluate the efficacy of AugSBP and AugMAP in predicting post-TAVR mortality.
• To compare the predictive performance of these new parameters against the Society of Thoracic Surgeons (STS) risk score.

Main Methods:

• Utilized data from the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database (2012-2017).
• Analyzed 974 patients, assessing AugSBP, AugMAP, and valvulo-arterial impedance (Zva) using Cox regression.
• Employed receiver operating characteristic (ROC) curve analysis and c-index to compare model performance with the STS risk score.

Main Results:

• AugSBP and AugMAP were identified as independent predictors of intermediate-term post-TAVR mortality (p < 0.0001).
• AugMAP1 < 102.5 mmHg significantly increased 1-year all-cause mortality risk (HR 3.0, p < 0.0001).
• The AugMAP1 model demonstrated superior predictive accuracy over the STS risk score (AUC: 0.700 vs. 0.587, p = 0.005; c-index: 0.681 vs. 0.585, p = 0.001).

Conclusions:

• Augmented mean arterial pressure (AugMAP) serves as a simple yet effective tool for risk stratification in post-TAVR patients.
• This parameter can help clinicians identify at-risk individuals, potentially improving patient prognosis after TAVR.