Abstract | OBJECTIVES: BACKGROUND: Hemodynamic parameters such as the ARI complement predominantly angiographically guided TAVR. However, the ARI depends on several baseline and periprocedural characteristics. METHODS: The ARI was prospectively calculated before and after TAVR in 600 patients. The severity of PVR was assessed in all patients by angiography and echocardiography according to a 3-class scheme. To account for pre-procedural hemodynamic status, the ARI ratio was calculated as post- over pre-procedural ARI. RESULTS: Apart from the degree of PVR (β = -0.396, p < 0.001), pre-procedural hemodynamic status in the form of the ARI before TAVR (β = 0.227, p < 0.001) was associated with post-procedural ARI in multivariate regression analysis. The ARI ratio increased the specificity of post-procedural ARI alone for the prediction of both more than mild PVR and 1-year mortality from 75.1% to 93.2% and from 75.0% to 93.3%, respectively. Patients with post-procedural ARI values <25 after TAVR had significantly increased 1-year mortality only when the ARI ratio was <0.60 (50.0% vs. 26.3%, p = 0.001). CONCLUSIONS: The ARI ratio integrating pre- and post-procedural hemodynamic status increases the discriminatory value of post-procedural ARI. The ARI ratio, which reflects acute hemodynamic changes after TAVR, is useful to identify patients with negative outcomes.
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Authors | Jan-Malte Sinning, Anja Stundl, Simon Pingel, Marcel Weber, Alexander Sedaghat, Christoph Hammerstingl, Mariuca Vasa-Nicotera, Fritz Mellert, Wolfgang Schiller, Jan Kovac, Armin Welz, Eberhard Grube, Nikos Werner, Georg Nickenig |
Journal | JACC. Cardiovascular interventions
(JACC Cardiovasc Interv)
Vol. 9
Issue 7
Pg. 700-11
(Apr 11 2016)
ISSN: 1876-7605 [Electronic] United States |
PMID | 27056309
(Publication Type: Journal Article)
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Copyright | Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Topics |
- Aged
- Aged, 80 and over
- Aortic Valve
(diagnostic imaging, physiopathology)
- Aortic Valve Insufficiency
(diagnostic imaging, mortality, physiopathology, therapy)
- Aortic Valve Stenosis
(diagnostic imaging, physiopathology, therapy)
- Cardiac Catheterization
(adverse effects, instrumentation, mortality)
- Chi-Square Distribution
- Coronary Angiography
- Decision Support Techniques
- Discriminant Analysis
- Echocardiography
- Female
- Heart Valve Prosthesis
- Heart Valve Prosthesis Implantation
(adverse effects, instrumentation, mortality)
- Hemodynamics
- Humans
- Kaplan-Meier Estimate
- Linear Models
- Male
- Multivariate Analysis
- Predictive Value of Tests
- Proportional Hazards Models
- Prospective Studies
- Prosthesis Design
- Registries
- Risk Factors
- Severity of Illness Index
- Time Factors
- Treatment Outcome
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