The influence of left ventricular hypertrophy on mortality in patients undergoing transcatheter aortic valve replacement
Danielle D. Spragan, Fenton McCarthy, Katherine McDermott, Saif Anwaruddin, Jay Giri, Wilson Szeto, Howard Herrmann, Joseph Bavaria, Nimesh Desai.
Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
OBJECTIVE: Severe left ventricular hypertrophy (LVH) is known to increase mortality risk in patients undergoing surgical aortic valve replacement. It is unknown whether severe LVH also increases the risk of mortality after transcatheter aortic valve replacement (TAVR). This study aims to determine the effect of left ventricular hypertrophy (as indicated by increased relative wall thickness on preoperative echocardiogram) on 30-day and late mortality in patients undergoing TAVR.
METHODS: A retrospective review of a single institution TAVR database from 2007 - 2014 was conducted to review preoperative echocardiograms. Six hundred thirty three patients were identified. Severe LVH is defined in this study as relative wall thickness (RWT) > 0.45, a validated measure of concentric LVH. Patients were stratified into groups with severe LVH (RWT > 0.45) and those without severe LVH (RWT < 0.45). Logistic regression analysis was used to examine the effect of RWT on 30-day mortality after TAVR and Kaplan Meier curves were created to plot the effects of RWT on late mortality.
RESULTS: Echocardiograms were reviewed from 633 patients and these individuals were stratified into those without severe LVH as measured by RWT 0.45 (RWT 0.64 + 0.18, n =411). Logistic regression analysis revealed similar 30-day mortality in patients with and without LVH (n=18, 8% vs n=23, 6%, p=0.24). However, late mortality was increased in patients with preoperative evidence of LVH at 12 mos (logrank p<0.001, Figure 1). Patients with severe LVH were noted to be slightly older (84.1yrs + 7.1 vs 82.0yrs + 7.88, p=0.001) and more likely to be female (56% vs 39%, p<0.001). STS score was similar for both groups of patients (10.6 + 4.3 vs 10.5 +4.3, p=0.84).
CONCLUSIONS: Preoperative LVH is predictive of increased mortality risk in patients planning to undergo transcatheter aortic valve replacement. Preoperative risk stratification should include elevated RWT on echocardiogram to help inform surgical management.
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