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Prognostic Impact of Invasive Hemodynamic Measurements in Combination with Clinical and Echocardiographic Characteristics on 2-year Clinical Outcomes of Patients undergoing Transcatheter Aortic Valve Implantation.

Research paper by Anna A Franzone, Crochan J CJ O'Sullivan, Stefan S Stortecky, Dik D Heg, Jonas J Lanz, René R Vollenbroich, Fabien F Praz, Raffaele R Piccolo, Masahiko M Asami, Eva E Roost, Lorenz L Räber, Marco M Valgimigli, Stephan S Windecker, Thomas T Pilgrim

Indexed on: 25 Jan '17Published on: 25 Jan '17Published in: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology



Abstract

To evaluate the prognostic utility of right heart catheterization (RHC)-derived measures among patients undergoing transcatheter aortic valve implantation (TAVI).Data of 469 patients included in the Bern TAVI Registry between August 2007 and December 2012 and undergoing pre-operative RHC were analyzed. The relationship between hemodynamic parameters and survival was evaluated with Cox proportional hazard models. At 2-year follow-up, 118 patients had died (25.1%). At multivariate analyses, diabetes (hazard ratio, HR, 1.95, 95% confidence intervals, CI, 1.28-2.96, p=0.001), transapical access (HR 1.66, 95% CI 1.07-2.56, p=0.02) and moderate or severe mitral regurgitation (HR 1.55, 95% CI 1.00-2.39, p=0.04) were independent predictors of 2-year mortality whereas no correlation between RHC-derived measures and mortality was found. Furthermore, the addition of hemodynamic variables did not significantly improve the prognostic power of a model incorporating clinical and echocardiographic data (Harrell's C index: 0.667, 95% CI 0.615-0.719 vs. 0.662, 95% CI 0.612-0.713, p=0.47).On the background of a comprehensive clinical and echocardiographic evaluation, RHC performed prior to TAVI does not add incremental prognostic value.

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