RT Journal Article
T1 Mitral Regurgitation in Low-Flow, Low-Gradient Aortic Stenosis Patients Undergoing TAVR: Insights From the TOPAS-TAVI Registry.
A1 Freitas-Ferraz, Afonso B
A1 Lerakis, Stamatios
A1 Barbosa Ribeiro, Henrique
A1 Gilard, Martine
A1 Cavalcante, João L
A1 Makkar, Raj
A1 Herrmann, Howard C
A1 Windecker, Stephan
A1 Enriquez-Sarano, Maurice
A1 Cheema, Asim N
A1 Nombela-Franco, Luis
A1 Amat-Santos, Ignacio
A1 Muñoz-García, Antonio J
A1 Garcia Del Blanco, Bruno
A1 Zajarias, Alan
A1 Lisko, John C
A1 Hayek, Salim
A1 Babaliaros, Vasilis
A1 Le Ven, Florent
A1 Gleason, Thomas G
A1 Chakravarty, Tarun
A1 Szeto, Wilson Y
A1 Clavel, Marie-Annick
A1 de Agustin, Alberto
A1 Serra, Vicenç
A1 Schindler, John T
A1 Dahou, Abdellaziz
A1 Annabi, Mohamed-Salah
A1 Pelletier-Beaumont, Emilie
A1 Pibarot, Philippe
A1 Rodés-Cabau, Josep
K1 low-flow low-gradient aortic stenosis
K1 mitral regurgitation
K1 reduced left ventricular ejection fraction
K1 transcatheter aortic valve replacement
AB This study sought to determine the incidence, clinical impact, and changes over time of mitral regurgitation (MR) in patients with low-flow, low-gradient aortic stenosis (LFLG-AS) undergoing transcatheter aortic valve replacement (TAVR). Few data exist on the clinical impact and changes in severity over time of MR in patients with LFLG-AS undergoing TAVR. A total of 308 TAVR candidates with LFLG-AS were included. Patients were categorized according to MR severity at baseline, and presence of MR improvement at 12-month follow-up. Clinical outcomes were assessed at 1 and 12 months (+ echocardiography), and yearly thereafter. Baseline mild and moderate-to-severe MR were present in 118 (38.3%) and 115 (37.3%) patients, respectively. MR was of functional and mixed etiology in 77.2% and 22.7% of patients, respectively. A total of 131 patients (42.5%) died after a median follow-up of 2 (1 to 3) years. Baseline moderate-or-greater MR had no impact on mortality (hazard ratio [HR]: 1.34; 95% confidence interval [CI]: 0.72 to 2.48) or heart failure hospitalization (HR: 1.02; 95% CI: 0.49 to 2.10). At 1-year follow-up, MR improved in 44.3% of patients and remained unchanged/worsened in 55.7%. The lack of MR improvement was associated with a higher risk of all-cause and cardiac mortality (HR: 2.02; 95% CI: 1.29 to 3.17; HR: 3.03; 95% CI: 1.27 to 7.23, respectively), rehospitalization for cardiac causes (HR: 1.50; 95% CI: 1.04 to 2.15), and an increased overall-mortality/heart failure rehospitalization (HR: 1.94; 95% CI: 1.25 to 3.02). A higher baseline left ventricular end-diastolic diameter and a higher increase in left ventricular ejection fraction were found to be independent predictors of MR improvement at 1-year follow-up (odds ratio: 0.69; 95% CI: 0.51 to 0.94; and odds ratio: 0.81; 95% CI: 0.67 to 0.96, respectively). Most TAVR candidates with LFLG-AS had some degree of MR, of functional origin in most cases. MR improved in about one-half of patients, with larger left ventricular size and a higher increase in left ventricular ejection fraction post-TAVR determining MR improvement over time. The lack of MR improvement at 1 year was associated with poorer outcomes.
YR 2020
FD 2020-02-12
LK http://hdl.handle.net/10668/15113
UL http://hdl.handle.net/10668/15113
LA en
DS RISalud
RD Apr 18, 2025