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Original article
DOI: 10.1016/j.rec.2019.06.006
Available online 7 September 2019
Predictors and outcomes of heart failure after transcatheter aortic valve implantation using a self-expanding prosthesis
Predictores e impacto pronóstico de la insuficiencia cardiaca tras el implante percutáneo de válvula aórtica con una prótesis autoexpandible
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Adrián Cid-Menéndeza, Diego López-Oteroa,b,
Corresponding author
birihh@yahoo.es

Corresponding author: Hospital Clínico Universitario de Santiago de Compostela, Travesía Choupana s/n, 15706 Santiago de Compostela, A Coruña, Spain.
, Rocío González-Ferreiroc, Diego Iglesias-Álvareza, Leyre Álvarez-Rodrígueza, Pablo J. Antúnez-Muiñosa, Belén Cid-Álvareza, Xoan Sanmartin-Penaa, Ramiro Trillo-Nouchea,b, José R. González-Juanateya,b
a Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
b Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
c Departamento de Cardiología, Hospital Universitario de Salamanca, Salamanca, Spain
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Received 29 November 2018. Accepted 26 June 2019
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Tables (4)
Table 1. Baseline characteristics of the total population and of each group
Table 2. Results of the multivariate analysis
Table 3. Factors associated with higher mortality
Table 4. Predictive factors for mortality in the subgroup of patients developing HF during follow-up
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Abstract
Introduction and objectives

The purpose of this analysis was to assess the incidence, predictors and prognostic impact of acute heart failure (AHF) after transcatheter aortic valve implantation (TAVI) using a self-expanding prosthesis.

Methods

From November 2008 to June 2017, all consecutive patients undergoing TAVI in our center were prospectively included in our TAVI registry. The predictive effect of AHF on all-cause mortality following the TAVI procedure was analyzed using Cox regression models.

Results

A total of 399 patients underwent TAVI with a mean age of 82.4 ± 5.8 years, of which 213 (53.4%) were women. During follow-up (27.0 ± 24.1 months), 29.8% (n = 119) were admitted due to AHF, which represents a cumulative incidence function of 13.2% (95%CI, 11.1%-15.8%). At the end of follow-up, 150 patients (37.59%) had died. Those who developed AHF showed a significantly higher mortality rate (52.1% vs 31.4%; HR, 1.84; 95%; CI, 1.14-2.97; P = .012). Independent predictors of AHF after TAVI were a past history of heart failure (P = .019) and high Society of Thoracic Surgeons score (P = .004). We found that nutritional risk index and chronic obstructive pulmonary disease were strongly correlated with outcomes in the AHF group.

Conclusions

TAVI was associated with a high incidence of clinical AHF. Those who developed AHF had higher mortality. Pre-TAVI AHF and high Society of Thoracic Surgeons score were the only independent predictors of AHF in our cohort. A low nutritional risk index and chronic obstructive pulmonary disease were independent markers of mortality in the AHF group.

Keywords:
Heart failure
Transcatheter aortic valve implantation
Nutritional risk
Abbreviations:
HF
NRI
STS
TAVI
Resumen
Introducción y objetivos

El objetivo es analizar la incidencia, los predictores y el impacto pronóstico de la insuficiencia cardiaca (IC) aguda tras el implante percutáneo de una válvula aórtica (TAVI) con una prótesis autoexpandible.

Métodos

Desde 2008, se incluye prospectivamente en nuestro registro de TAVI a todos los pacientes sometidos a TAVI en nuestro centro. Se analizan los factores pronósticos determinantes de IC aguda, y la relación con la mortalidad mediante modelos de regresión de Cox.

Resultados

Se sometieron a TAVI 399 pacientes, con una media de edad de 82,4 ± 5,8 años, de los que 213 (53,4%) eran mujeres. Durante el seguimiento (27,0 ± 24,1 meses), el 29,8% de los pacientes (n = 119) ingresaron en el hospital con el diagnóstico de IC aguda, lo que representa una incidencia anual del 13,2% (IC95%, 11,1-15,8%). Al final del seguimiento, habían fallecido 150 pacientes (37,59%). En el grupo de IC aguda se evidenció una tasa de mortalidad significativamente mayor (el 52,1 frente al 31,4%; HR = 1,84; IC95%, 1,14-2,97; p < 0,012). El diagnóstico previo de IC (p = 0,019) y la puntuación de la Society of Thoracic Surgeons (p = 0,004) se identificaron como predictores independientes de IC aguda tras el TAVI. Además, el índice de riesgo nutricional y la enfermedad pulmonar obstructiva crónica son los principales factores que ensombrecen el pronóstico dentro del grupo de IC aguda.

Conclusiones

El TAVI se asocia con una alta incidencia de eventos de IC aguda, lo que supone un gran impacto en la mortalidad. La IC aguda previa al implante y la puntuación de la Society of Thoracic Surgeons fueron los únicos predictores de IC aguda hallados. Un índice de riesgo nutricional bajo y la enfermedad pulmonar obstructiva crónica son potentes determinantes de mortalidad en el grupo de IC aguda.

Palabras clave:
Insuficiencia cardiaca
Implante percutáneo de válvula aórtica
Riesgo nutricional

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