Prognostic Impact of Low-Flow Severe Aortic Stenosis in Small-Body Patients Undergoing TAVR. The OCEAN-TAVI Registry

Akihisa Kataoka, Yusuke Watanabe, Ken Kozuma, Yugo Nara, Fukuko Nagura, Hideyuki Kawashima, Hirofumi Hioki, Makoto Nakashima, Masanori Yamamoto, Kensuke Takagi, Motoharu Araki, Norio Tada, Shinichi Shirai, Futoshi Yamanaka, Kentaro Hayashida

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objectives: This study aimed to analyze the prognostic impact of low-flow (LF) severe aortic stenosis in small-body patients undergoing transcatheter aortic valve replacement (TAVR). Background: Western literature demonstrates a poor prognosis with paradoxical LF and low-flow low-gradient (LF-LG) severe aortic stenosis (AS), as defined by stroke volume index (SVi) <35 ml/m2 and mean pressure gradient <40 mm Hg with preserved left ventricular ejection fraction (LVEF). However, this poor prognosis is contested in Japan owing to the smaller body size of Japanese patients relative to that of Western patients. Additionally, there are no reports of the prognostic implication of paradoxical LF or LF-LG severe AS in small-body patients undergoing TAVR. Methods: This was a retrospective analysis of 723 consecutive Japanese patients (median age 85 years; 32.6% male; median body surface area 1.4 m2) who underwent TAVR for severe AS at 9 sites in Japan. The primary and secondary endpoints were cumulative all-cause and cardiovascular mortality after TAVR, respectively. Results: Ninety-seven (13.4%) patients had paradoxical LF severe AS whereas 38 (5.3%) had paradoxical LF-LG with severe AS. PLF was associated with a significant increase in all-cause (hazard ratio [HR]: 3.00; 95% confidence interval [CI]: 1.34 to 6.72; p < 0.001) and cardiovascular mortality (HR: 5.58; 95% CI: 1.19 to 26.2; p < 0.01), as compared with patients' normal flow and preserved LVEF. PLF-LG was associated with a significant increase in all-cause mortality (HR: 3.76; 95% CI: 1.09 to 13.73; p < 0.01), as compared with normal flow high gradient with preserved LVEF. SVi was an independent predictor of cardiovascular mortality on multivariate analysis after adjustments for age, sex, clinically relevant variables, and other echocardiographic parameters (HR: 1.96; 95% CI: 1.19 to 3.23; p < 0.01). Conclusions: Among Japanese small-body patients with severe AS, both paradoxical LF and LF-LG severe AS were associated with poor outcomes following TAVR. SVi was an independent predictor of cardiovascular mortality after TAVR. (Optimised Transcatheter Valvular Intervention registry [OCEAN-TAVI]; UMIN000020423).

Original languageEnglish
JournalJACC: Cardiovascular Imaging
DOIs
Publication statusAccepted/In press - 2016 Aug 22

Fingerprint

Aortic Valve Stenosis
Registries
Stroke Volume
Mortality
Confidence Intervals
Japan
Transcatheter Aortic Valve Replacement
Body Surface Area
Body Size
Multivariate Analysis
Pressure

Keywords

  • Paradoxical low-flow low-gradient severe aortic stenosis
  • Paradoxical low-flow severe aortic stenosis
  • Small body
  • Stroke volume index
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic Impact of Low-Flow Severe Aortic Stenosis in Small-Body Patients Undergoing TAVR. The OCEAN-TAVI Registry. / Kataoka, Akihisa; Watanabe, Yusuke; Kozuma, Ken; Nara, Yugo; Nagura, Fukuko; Kawashima, Hideyuki; Hioki, Hirofumi; Nakashima, Makoto; Yamamoto, Masanori; Takagi, Kensuke; Araki, Motoharu; Tada, Norio; Shirai, Shinichi; Yamanaka, Futoshi; Hayashida, Kentaro.

In: JACC: Cardiovascular Imaging, 22.08.2016.

Research output: Contribution to journalArticle

Kataoka, A, Watanabe, Y, Kozuma, K, Nara, Y, Nagura, F, Kawashima, H, Hioki, H, Nakashima, M, Yamamoto, M, Takagi, K, Araki, M, Tada, N, Shirai, S, Yamanaka, F & Hayashida, K 2016, 'Prognostic Impact of Low-Flow Severe Aortic Stenosis in Small-Body Patients Undergoing TAVR. The OCEAN-TAVI Registry', JACC: Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2016.12.028
Kataoka, Akihisa ; Watanabe, Yusuke ; Kozuma, Ken ; Nara, Yugo ; Nagura, Fukuko ; Kawashima, Hideyuki ; Hioki, Hirofumi ; Nakashima, Makoto ; Yamamoto, Masanori ; Takagi, Kensuke ; Araki, Motoharu ; Tada, Norio ; Shirai, Shinichi ; Yamanaka, Futoshi ; Hayashida, Kentaro. / Prognostic Impact of Low-Flow Severe Aortic Stenosis in Small-Body Patients Undergoing TAVR. The OCEAN-TAVI Registry. In: JACC: Cardiovascular Imaging. 2016.
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abstract = "Objectives: This study aimed to analyze the prognostic impact of low-flow (LF) severe aortic stenosis in small-body patients undergoing transcatheter aortic valve replacement (TAVR). Background: Western literature demonstrates a poor prognosis with paradoxical LF and low-flow low-gradient (LF-LG) severe aortic stenosis (AS), as defined by stroke volume index (SVi) <35 ml/m2 and mean pressure gradient <40 mm Hg with preserved left ventricular ejection fraction (LVEF). However, this poor prognosis is contested in Japan owing to the smaller body size of Japanese patients relative to that of Western patients. Additionally, there are no reports of the prognostic implication of paradoxical LF or LF-LG severe AS in small-body patients undergoing TAVR. Methods: This was a retrospective analysis of 723 consecutive Japanese patients (median age 85 years; 32.6{\%} male; median body surface area 1.4 m2) who underwent TAVR for severe AS at 9 sites in Japan. The primary and secondary endpoints were cumulative all-cause and cardiovascular mortality after TAVR, respectively. Results: Ninety-seven (13.4{\%}) patients had paradoxical LF severe AS whereas 38 (5.3{\%}) had paradoxical LF-LG with severe AS. PLF was associated with a significant increase in all-cause (hazard ratio [HR]: 3.00; 95{\%} confidence interval [CI]: 1.34 to 6.72; p < 0.001) and cardiovascular mortality (HR: 5.58; 95{\%} CI: 1.19 to 26.2; p < 0.01), as compared with patients' normal flow and preserved LVEF. PLF-LG was associated with a significant increase in all-cause mortality (HR: 3.76; 95{\%} CI: 1.09 to 13.73; p < 0.01), as compared with normal flow high gradient with preserved LVEF. SVi was an independent predictor of cardiovascular mortality on multivariate analysis after adjustments for age, sex, clinically relevant variables, and other echocardiographic parameters (HR: 1.96; 95{\%} CI: 1.19 to 3.23; p < 0.01). Conclusions: Among Japanese small-body patients with severe AS, both paradoxical LF and LF-LG severe AS were associated with poor outcomes following TAVR. SVi was an independent predictor of cardiovascular mortality after TAVR. (Optimised Transcatheter Valvular Intervention registry [OCEAN-TAVI]; UMIN000020423).",
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T1 - Prognostic Impact of Low-Flow Severe Aortic Stenosis in Small-Body Patients Undergoing TAVR. The OCEAN-TAVI Registry

AU - Kataoka, Akihisa

AU - Watanabe, Yusuke

AU - Kozuma, Ken

AU - Nara, Yugo

AU - Nagura, Fukuko

AU - Kawashima, Hideyuki

AU - Hioki, Hirofumi

AU - Nakashima, Makoto

AU - Yamamoto, Masanori

AU - Takagi, Kensuke

AU - Araki, Motoharu

AU - Tada, Norio

AU - Shirai, Shinichi

AU - Yamanaka, Futoshi

AU - Hayashida, Kentaro

PY - 2016/8/22

Y1 - 2016/8/22

N2 - Objectives: This study aimed to analyze the prognostic impact of low-flow (LF) severe aortic stenosis in small-body patients undergoing transcatheter aortic valve replacement (TAVR). Background: Western literature demonstrates a poor prognosis with paradoxical LF and low-flow low-gradient (LF-LG) severe aortic stenosis (AS), as defined by stroke volume index (SVi) <35 ml/m2 and mean pressure gradient <40 mm Hg with preserved left ventricular ejection fraction (LVEF). However, this poor prognosis is contested in Japan owing to the smaller body size of Japanese patients relative to that of Western patients. Additionally, there are no reports of the prognostic implication of paradoxical LF or LF-LG severe AS in small-body patients undergoing TAVR. Methods: This was a retrospective analysis of 723 consecutive Japanese patients (median age 85 years; 32.6% male; median body surface area 1.4 m2) who underwent TAVR for severe AS at 9 sites in Japan. The primary and secondary endpoints were cumulative all-cause and cardiovascular mortality after TAVR, respectively. Results: Ninety-seven (13.4%) patients had paradoxical LF severe AS whereas 38 (5.3%) had paradoxical LF-LG with severe AS. PLF was associated with a significant increase in all-cause (hazard ratio [HR]: 3.00; 95% confidence interval [CI]: 1.34 to 6.72; p < 0.001) and cardiovascular mortality (HR: 5.58; 95% CI: 1.19 to 26.2; p < 0.01), as compared with patients' normal flow and preserved LVEF. PLF-LG was associated with a significant increase in all-cause mortality (HR: 3.76; 95% CI: 1.09 to 13.73; p < 0.01), as compared with normal flow high gradient with preserved LVEF. SVi was an independent predictor of cardiovascular mortality on multivariate analysis after adjustments for age, sex, clinically relevant variables, and other echocardiographic parameters (HR: 1.96; 95% CI: 1.19 to 3.23; p < 0.01). Conclusions: Among Japanese small-body patients with severe AS, both paradoxical LF and LF-LG severe AS were associated with poor outcomes following TAVR. SVi was an independent predictor of cardiovascular mortality after TAVR. (Optimised Transcatheter Valvular Intervention registry [OCEAN-TAVI]; UMIN000020423).

AB - Objectives: This study aimed to analyze the prognostic impact of low-flow (LF) severe aortic stenosis in small-body patients undergoing transcatheter aortic valve replacement (TAVR). Background: Western literature demonstrates a poor prognosis with paradoxical LF and low-flow low-gradient (LF-LG) severe aortic stenosis (AS), as defined by stroke volume index (SVi) <35 ml/m2 and mean pressure gradient <40 mm Hg with preserved left ventricular ejection fraction (LVEF). However, this poor prognosis is contested in Japan owing to the smaller body size of Japanese patients relative to that of Western patients. Additionally, there are no reports of the prognostic implication of paradoxical LF or LF-LG severe AS in small-body patients undergoing TAVR. Methods: This was a retrospective analysis of 723 consecutive Japanese patients (median age 85 years; 32.6% male; median body surface area 1.4 m2) who underwent TAVR for severe AS at 9 sites in Japan. The primary and secondary endpoints were cumulative all-cause and cardiovascular mortality after TAVR, respectively. Results: Ninety-seven (13.4%) patients had paradoxical LF severe AS whereas 38 (5.3%) had paradoxical LF-LG with severe AS. PLF was associated with a significant increase in all-cause (hazard ratio [HR]: 3.00; 95% confidence interval [CI]: 1.34 to 6.72; p < 0.001) and cardiovascular mortality (HR: 5.58; 95% CI: 1.19 to 26.2; p < 0.01), as compared with patients' normal flow and preserved LVEF. PLF-LG was associated with a significant increase in all-cause mortality (HR: 3.76; 95% CI: 1.09 to 13.73; p < 0.01), as compared with normal flow high gradient with preserved LVEF. SVi was an independent predictor of cardiovascular mortality on multivariate analysis after adjustments for age, sex, clinically relevant variables, and other echocardiographic parameters (HR: 1.96; 95% CI: 1.19 to 3.23; p < 0.01). Conclusions: Among Japanese small-body patients with severe AS, both paradoxical LF and LF-LG severe AS were associated with poor outcomes following TAVR. SVi was an independent predictor of cardiovascular mortality after TAVR. (Optimised Transcatheter Valvular Intervention registry [OCEAN-TAVI]; UMIN000020423).

KW - Paradoxical low-flow low-gradient severe aortic stenosis

KW - Paradoxical low-flow severe aortic stenosis

KW - Small body

KW - Stroke volume index

KW - Transcatheter aortic valve implantation

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