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Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Mar 25, 2025;

The Prognostic Implications of Change in LVEDP during TAVI.

Paul Bamford, Amr Abdelrahman, Nadir Elamin, Rowan Hall, Amanda Sherwen, Kate V Gatenby, Amir Aziz, Suleman Aktaa, Christopher J Malkin, Michael S Cunnington, Daniel J Blackman, Noman Ali
Author Information
  1. Paul Bamford: Department of Cardiology, Leeds General Infirmary, Leeds, UK. ORCID
  2. Amr Abdelrahman: Department of Cardiology, Leeds General Infirmary, Leeds, UK.
  3. Nadir Elamin: Department of Cardiology, Northern General Hospital, Sheffield, UK.
  4. Rowan Hall: Department of Cardiology, Leeds General Infirmary, Leeds, UK.
  5. Amanda Sherwen: Department of Cardiology, Leeds General Infirmary, Leeds, UK.
  6. Kate V Gatenby: Department of Cardiology, Leeds General Infirmary, Leeds, UK.
  7. Amir Aziz: Department of Cardiology, Northern General Hospital, Sheffield, UK.
  8. Suleman Aktaa: Department of Cardiology, Leeds General Infirmary, Leeds, UK.
  9. Christopher J Malkin: Department of Cardiology, Leeds General Infirmary, Leeds, UK.
  10. Michael S Cunnington: Department of Cardiology, Leeds General Infirmary, Leeds, UK.
  11. Daniel J Blackman: Department of Cardiology, Leeds General Infirmary, Leeds, UK. ORCID
  12. Noman Ali: Department of Cardiology, Leeds General Infirmary, Leeds, UK.
PMID: 40134255 DOI: 10.1002/ccd.31508

Abstract

BACKGROUND: Elevated left ventricular end diastolic pressure (LVEDP) following transcatheter aortic valve implantation (TAVI) has been identified as a predictor of heart failure and mortality.
AIMS: To determine whether change in LVEDP is a more powerful predictor of adverse clinical outcomes than elevated LVEDP post-TAVI.
METHODS: Patients who underwent TAVI at two high volume centers between January 2013 and December 2023 were screened for inclusion. LVEDP measurements were taken before and immediately after TAVI. Hospital records were analyzed for mortality and heart failure hospitalization (HFH). Patients were stratified into those whose LVEDP decreased (post-TAVI LVEDP > 5 mmHg lower), didn't change (±5 mmHg) or increased (post-TAVI LVEDP > 5 mmHg higher).
RESULTS: A total of 1073 patients were included. The median follow-up period was 28.9 months with 15.5% followed up for over 5 years. Increase in LVEDP was associated with increased incidence of 5-year mortality (40.3% vs. 28.4% vs. 23.2%; p < 0.001) and HFH (23.3% vs. 10.0% vs. 7.1%; p < 0.001) compared to no change or decrease in LVEDP. On multivariate analysis, increase in LVEDP post-TAVI was an independent predictor of all-cause mortality and HFH. Elevated LVEDP (> 15 mmHg) alone post-TAVI was predictive of HFH but not mortality.
CONCLUSIONS: Patients in whom LVEDP increases post-TAVI have a significantly higher incidence of mortality and HFH within 1 month, and this persists for at least 5-years post-procedure. According to our results, the change in LVEDP is a more powerful predictor of adverse clinical outcomes than elevated post-TAVI LVEDP alone.

Keywords

TAVI aortic stenosis heart failure mortality

References

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Grants

  1. /The authors received no specific funding for this work.
Journal Article

Word Cloud

Created with Highcharts 10.0.0LVEDPmortalitypost-TAVITAVIHFHpredictorchangevsheartfailurePatientsElevatedaorticpowerfuladverseclinicaloutcomeselevated> 5 mmHgincreasedhigher28incidence3%23p < 0001aloneBACKGROUND:leftventricularenddiastolicpressurefollowingtranscathetervalveimplantationidentifiedAIMS:determinewhetherMETHODS:underwenttwohighvolumecentersJanuary2013December2023screenedinclusionmeasurementstakenimmediatelyHospitalrecordsanalyzedhospitalizationstratifiedwhosedecreasedlower±5 mmHgRESULTS:total1073patientsincludedmedianfollow-upperiod9months155%followed5yearsIncreaseassociated5-year404%2%100%71%compareddecreasemultivariateanalysisincreaseindependentall-cause> 15 mmHgpredictiveCONCLUSIONS:increasessignificantlywithin1monthpersistsleast5-yearspost-procedureAccordingresultsPrognosticImplicationsChangestenosis

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