Causes of death and predictors of survival after aortic valve replacement in low flow vs. normal flowsevere aortic stenosiswith preserved ejection fraction

Mackram Eleid, Hector I Michelena, Vuyisile T Nkomo, Rick A. Nishimura, Joseph F. Malouf, Christopher G. Scott, Patricia Pellikka

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15 Citations (Scopus)

Abstract

Aims Reduced stroke volume index (SVI) in patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) is associated with adverse outcomes even after aortic valve replacement (AVR), although specific reasons for impaired survival in this group are unknown.We investigated predictors of post-AVR survival and specific cause of death in patients with AS according to SVI. Methods and results Among 1120 consecutive patients with severe AS (aortic valve area 2) and preserved EF (≥50%) using 2-D and Doppler echocardiography who hadAVR, 61 (5%) patients had reduced SVI [≥35 mL/m2 (lowflow, LF)] and 1059 (95%) had normal SVI [≥35 mL/m2 (normal flow, NF)]. Survival post-AVR was lower in patients with LF compared with NF [3-year survival in LF group 76% (95% CI 70.82) vs. 89% (95% CI 88.90%), P = 0.03] primarily due to higher cardiac mortality [3-year event rate 13% (95% CI 8.18%) in LF vs. 5%(95% CI 5.7%) inNF, P = 0.02].Congestive heart failure (CHF) was the most common cause of cardiac death in the LF group (57% of post-AVR cardiac deaths) andwas a more frequent cause of death in LF compared with NF (3-year risk 7 vs. 2%, P = 0.008). Multivariable predictors of post-AVR mortality included age, creatinine, haemoglobin, right ventricular systolic pressure, SVI, and cognitive impairment. Conclusion Reduced SVI is associated with higher cardiac mortality afterAVR.CHFis the predominant cause of cardiac mortality after AVR in patients with LF, suggesting the presence of persistent myocardial impairment in this population.

Original languageEnglish (US)
Pages (from-to)1270-1275
Number of pages6
JournalEuropean Heart Journal Cardiovascular Imaging
Volume16
Issue number11
DOIs
StatePublished - 2015

Fingerprint

Aortic Valve
Cause of Death
Stroke Volume
Survival
Aortic Valve Stenosis
Mortality
Doppler Echocardiography
Ventricular Pressure
Creatinine
Hemoglobins
Heart Failure
Blood Pressure
Population

Keywords

  • aortic stenosis
  • cause of death
  • stroke volume
  • surgery
  • survival
  • valves

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

@article{bc739b50f9c245bf8067123554166d2c,
title = "Causes of death and predictors of survival after aortic valve replacement in low flow vs. normal flowsevere aortic stenosiswith preserved ejection fraction",
abstract = "Aims Reduced stroke volume index (SVI) in patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) is associated with adverse outcomes even after aortic valve replacement (AVR), although specific reasons for impaired survival in this group are unknown.We investigated predictors of post-AVR survival and specific cause of death in patients with AS according to SVI. Methods and results Among 1120 consecutive patients with severe AS (aortic valve area 2) and preserved EF (≥50{\%}) using 2-D and Doppler echocardiography who hadAVR, 61 (5{\%}) patients had reduced SVI [≥35 mL/m2 (lowflow, LF)] and 1059 (95{\%}) had normal SVI [≥35 mL/m2 (normal flow, NF)]. Survival post-AVR was lower in patients with LF compared with NF [3-year survival in LF group 76{\%} (95{\%} CI 70.82) vs. 89{\%} (95{\%} CI 88.90{\%}), P = 0.03] primarily due to higher cardiac mortality [3-year event rate 13{\%} (95{\%} CI 8.18{\%}) in LF vs. 5{\%}(95{\%} CI 5.7{\%}) inNF, P = 0.02].Congestive heart failure (CHF) was the most common cause of cardiac death in the LF group (57{\%} of post-AVR cardiac deaths) andwas a more frequent cause of death in LF compared with NF (3-year risk 7 vs. 2{\%}, P = 0.008). Multivariable predictors of post-AVR mortality included age, creatinine, haemoglobin, right ventricular systolic pressure, SVI, and cognitive impairment. Conclusion Reduced SVI is associated with higher cardiac mortality afterAVR.CHFis the predominant cause of cardiac mortality after AVR in patients with LF, suggesting the presence of persistent myocardial impairment in this population.",
keywords = "aortic stenosis, cause of death, stroke volume, surgery, survival, valves",
author = "Mackram Eleid and Michelena, {Hector I} and Nkomo, {Vuyisile T} and Nishimura, {Rick A.} and Malouf, {Joseph F.} and Scott, {Christopher G.} and Patricia Pellikka",
year = "2015",
doi = "10.1093/ehjci/jev091",
language = "English (US)",
volume = "16",
pages = "1270--1275",
journal = "European Heart Journal Cardiovascular Imaging",
issn = "2047-2404",
publisher = "Oxford University Press",
number = "11",

}

TY - JOUR

T1 - Causes of death and predictors of survival after aortic valve replacement in low flow vs. normal flowsevere aortic stenosiswith preserved ejection fraction

AU - Eleid, Mackram

AU - Michelena, Hector I

AU - Nkomo, Vuyisile T

AU - Nishimura, Rick A.

AU - Malouf, Joseph F.

AU - Scott, Christopher G.

AU - Pellikka, Patricia

PY - 2015

Y1 - 2015

N2 - Aims Reduced stroke volume index (SVI) in patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) is associated with adverse outcomes even after aortic valve replacement (AVR), although specific reasons for impaired survival in this group are unknown.We investigated predictors of post-AVR survival and specific cause of death in patients with AS according to SVI. Methods and results Among 1120 consecutive patients with severe AS (aortic valve area 2) and preserved EF (≥50%) using 2-D and Doppler echocardiography who hadAVR, 61 (5%) patients had reduced SVI [≥35 mL/m2 (lowflow, LF)] and 1059 (95%) had normal SVI [≥35 mL/m2 (normal flow, NF)]. Survival post-AVR was lower in patients with LF compared with NF [3-year survival in LF group 76% (95% CI 70.82) vs. 89% (95% CI 88.90%), P = 0.03] primarily due to higher cardiac mortality [3-year event rate 13% (95% CI 8.18%) in LF vs. 5%(95% CI 5.7%) inNF, P = 0.02].Congestive heart failure (CHF) was the most common cause of cardiac death in the LF group (57% of post-AVR cardiac deaths) andwas a more frequent cause of death in LF compared with NF (3-year risk 7 vs. 2%, P = 0.008). Multivariable predictors of post-AVR mortality included age, creatinine, haemoglobin, right ventricular systolic pressure, SVI, and cognitive impairment. Conclusion Reduced SVI is associated with higher cardiac mortality afterAVR.CHFis the predominant cause of cardiac mortality after AVR in patients with LF, suggesting the presence of persistent myocardial impairment in this population.

AB - Aims Reduced stroke volume index (SVI) in patients with severe aortic stenosis (AS) and preserved ejection fraction (EF) is associated with adverse outcomes even after aortic valve replacement (AVR), although specific reasons for impaired survival in this group are unknown.We investigated predictors of post-AVR survival and specific cause of death in patients with AS according to SVI. Methods and results Among 1120 consecutive patients with severe AS (aortic valve area 2) and preserved EF (≥50%) using 2-D and Doppler echocardiography who hadAVR, 61 (5%) patients had reduced SVI [≥35 mL/m2 (lowflow, LF)] and 1059 (95%) had normal SVI [≥35 mL/m2 (normal flow, NF)]. Survival post-AVR was lower in patients with LF compared with NF [3-year survival in LF group 76% (95% CI 70.82) vs. 89% (95% CI 88.90%), P = 0.03] primarily due to higher cardiac mortality [3-year event rate 13% (95% CI 8.18%) in LF vs. 5%(95% CI 5.7%) inNF, P = 0.02].Congestive heart failure (CHF) was the most common cause of cardiac death in the LF group (57% of post-AVR cardiac deaths) andwas a more frequent cause of death in LF compared with NF (3-year risk 7 vs. 2%, P = 0.008). Multivariable predictors of post-AVR mortality included age, creatinine, haemoglobin, right ventricular systolic pressure, SVI, and cognitive impairment. Conclusion Reduced SVI is associated with higher cardiac mortality afterAVR.CHFis the predominant cause of cardiac mortality after AVR in patients with LF, suggesting the presence of persistent myocardial impairment in this population.

KW - aortic stenosis

KW - cause of death

KW - stroke volume

KW - surgery

KW - survival

KW - valves

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U2 - 10.1093/ehjci/jev091

DO - 10.1093/ehjci/jev091

M3 - Article

C2 - 25896358

AN - SCOPUS:84948679305

VL - 16

SP - 1270

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JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

SN - 2047-2404

IS - 11

ER -