Page 36 - Journal of Structural Heart Disease Volume 5, Issue 6

Original Scientific Article
260
Table 2. Univariable and multivariate cox regression analysis for predictors of all-cause 1-year mortality.
Variables
Univariate
Multivariate
HR (95% CI)
P-value
HR (95% CI)
P-value
Age
Gender (Male)
BMI
HTN
CAD
Diabetes
STS score
NYHA IV
Renal Disease (Cr>2)
Baseline LVEF
Post-TAVR LVEF, % (Day1)
AV Mean Gradient
Post-TAVR PVL
GLS, %
BLS, %
MD, msec
Adjust for: age, STS score, NYHA IV, renal disease, AV mean gradient, post-TAVR PVL
1.039 (0.99-1.09) 1.038 (0.49-2.17) 0.954 (0.90-1.01) 0.553 (0.13-2.32) 1.63 (0.67-4.10) 2.03 (0.96-4.30) 1.110 (1.04-1.19) 2.92 (1.28-6.63) 2.31 (1.02-5.24) 0.987 (0.96-1.01) 0.978 (0.95-1.01) 0.949 (0.92-0.97) 2.339 (1.45-3.75) 1.21 (1.08-1.34) 1.29 (1.12-1.47) 1.02 (1.01-1.03)
0.045 0.008 0.001
0.094
0.922
0.108
0.419
0.269
0.062
0.003
0.011
0.046
0.260
0.056
0.001
0.001
0.001 1.12 (1.01-1.24) 0.001 1.21 (1.05-1.40) 0.003 1.02 (1.01-1.04)
HR: Hazard ratio; BMI: body mass index; Cr: creatinine; NYHA: New York Heart Association; STS: Society of Thoracic Surgery; CAD: coronary artery disease; LVEF: left ventricular ejection fraction; AV: aortic valve; TAVR: trans-catheter aortic valve replacement; PVL: paravalvular leak; GLS: global longitudinal strain; BLS: basal longitudinal strain; MD: mechanical dispersion.
Conclusion
We demonstrated that post-TAVR BLS and MD are independent predictors of 1-year mortality in patients with severe AS. Our study further demonstrates the incremental prognostic utility of these parameters to known markers of poor out. Early assessment of myo- cardial strain and mechanical dispersion should be considered as new indices for identifying patients at risk for poor outcomes post-TAVR.
Limitations
Baseline myocardial strain data was not available before TAVR. Therefore, it was not possible to deter- mine whether pre- and post-TAVR strain parameters provide similar or different prognostic information. Another important limitation of our study is the lack
of enough data to calculate the delta change in myo- cardial strain post-TAVR which could be an additional prognostic variable in TAVR patients. Further studies are needed to determine the prognostic implication of this factor. Although internal validation confirmed our results, the differential performance of the mark- ers investigated here needs to be reexamined in larg- er study populations. More studies are needed to assess whether post-TAVR index-enhanced risk strat- ification can guide management decisions of post- TAVR patients, alongside with previous models.
Acknowledgments
All co-authors have contributed to the develop- ment of this research project and the writing of this manuscript.
Journal of Structural Heart Disease, December 2019
Volume 5, Issue 6:254-262