Prognostic value of algorithm-based invasive haemodynamic assessment of paravalvular regurgitation after transcatheter aortic valve replacement with self-expanding devices—the APPOSE registry

Le résumé fourni par la source

Abstract Background Detecting and grading paravalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR) remains challenging. Aims We evaluated the prognostic value of algorithm-based invasively measured haemodynamic indices of PVR for all-cause mortality and heart failure (HF) rehospitalizations. Methods and Results We included 727 patients who underwent TAVR with a self-expanding valve for severe native aortic stenosis between 2015 and 2021 at Radboudumc. Invasive left ventricular and aortic pressures were continuously measured and analysed offline using a validated algorithm for standardized computation of haemodynamic indices of PVR. The primary endpoint was an event-adjudicated composite of all-cause mortality and HF rehospitalization across 3-year follow-up. Algorithm-derived diastolic pressure–time index (DPTI) ≤58 and diastolic delta (DD) ≤32 mmHg were independently associated with the composite outcome (hazard ratio [HR] 1.64 [95% confidence interval (CI): 1.14, 2.37], HR 1.80 [95% CI: 1.21, 2.68], respectively). Following stratification for angiography-graded PVR, algorithm-derived invasive indices remained independently associated with the composite outcome in those with angiographic mild-moderate (HR DPTI ≤58 mmHg: 2.94, 95% CI: 1.68, 5.15) but not none/trace PVR (HR DPTI ≤58 mmHg: 0.91, 95% CI: 0.49, 1.69). Inferences remained consistent when considering only those with angiographic mild PVR (HR DPTI ≤58: 3.19, 95% CI: 1.62, 6.26). Conclusion Algorithm-based invasive assessment of PVR showed independent prognostic value for the risk of all-cause mortality and HF rehospitalization across 3-year follow-up. Additionally, following stratification for angiography-graded PVR, haemodynamic indices remained independently associated with the composite outcome in those with angiographic mild PVR. Together, this highlights the potential of real-time automated assessment of invasive haemodynamics for risk stratification of patients undergoing TAVR.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.