Abstract |
Despite major technological advances, 1-year morbi-mortality after transcatheter aortic valve implantation (TAVI) is still high. Further outcome improvements may be obtained provided proper identification of prognostic factors. A change of prognostic value over time should be the hallmark of an outcome-implicated factor. In 1,425 patients treated by TAVI, the examined prognostic factors were: demographic factors and co-morbidities (age, male gender, glomerular filtration rate, and chronic obstructive pulmonary disease), cardiac function (left ventricular ejection fraction, pulmonary pressure, aortic gradient, dyspnea, and mitral regurgitation), and vascular factors ( coronary artery disease, peripheral vascular disease (PVD), previous stroke, and thoracic aortic calcium-TAC-as assessed by CT scan). Cox models were used to analyze cardiovascular and all-cause mortalities over 3 years of follow-up. The time-dependent effects of the factors were analyzed using the distribution of Schoenfeld residuals. During the study period, 375 (26.3%) deaths occurred of whom 248 (17.4%) from cardiovascular causes. Only 2 factors associated with cardiovascular or all-cause mortality showed significant changes over time: dyspnea and PVD. The effect of dyspnea on cardiovascular mortality decreased over time (first- and third-year hazard ratios [95% confidence intervals]: 1.47 [1.10; 1.96] and 0.94 [0.55; 1.63], respectively), whereas the effect of PVD increased (first- and third-year hazard ratios: 0.87 [0.56; 1.35] and 2.58 [1.25; 5.33], respectively). TAC had a stable effect. In conclusion, the detrimental effects of vascular factors remained stable (TAC) or increased (PVD) over time. These factors should be targeted by specific measures to improve post-TAVI outcomes.
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Authors | Clément Bècle, Benjamin Riche, Muriel Rabilloud, Géraud Souteyrand, Hélène Eltchaninoff, Thierry Lefèvre, Brahim Harbaoui, Pierre Lantelme |
Journal | The American journal of cardiology
(Am J Cardiol)
Vol. 125
Issue 12
Pg. 1884-1889
(06 15 2020)
ISSN: 1879-1913 [Electronic] United States |
PMID | 32317099
(Publication Type: Journal Article, Multicenter Study)
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Copyright | Copyright © 2020 Elsevier Inc. All rights reserved. |
Topics |
- Adult
- Aged
- Cardiovascular Diseases
(complications, mortality)
- Female
- France
- Glomerular Filtration Rate
- Heart Diseases
(complications)
- Humans
- Male
- Middle Aged
- Postoperative Complications
(mortality)
- Pulmonary Disease, Chronic Obstructive
(complications)
- Risk Factors
- Sex Factors
- Transcatheter Aortic Valve Replacement
(adverse effects, mortality)
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