title: Echocardiographic and clinical factors related to paravalvular leak incidence in low-gradient severe aortic stenosis patients post-transcatheter aortic valve implantation.
abstract: BACKGROUND
  Paravalvular leak (PVL) following transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. The association of clinical and echocardiographic parameters in the occurrence of even mild PVL in patients with low-gradient severe aortic stenosis (LGSAS) after TAVI and predictors of all-cause mortality and re-hospitalization during 2-year follow-up was studied, as data are sparse in the literature.
  
  
  METHODS
  Seventy-five consecutive LGSAS patients (age 80 ± 8 years, 68% male, 89% Caucasians) were enrolled and followed-up for PVL development at hospital discharge, as well as mortality or re-hospitalization for cardiovascular disease, during a 2-year follow-up period. Patients' characteristics were retrospectively extracted from hospital's database. Mortality was determined either by chart review or the Social Security Death Index.
  
  
  RESULTS
  PVL was evident in 29 out of 75 patients. Patients with PVL had higher death rates at 6-month, 1-year of follow-up (27 vs. 7%, P = 0.05, 32 vs. 8%, P = 0.04, respectively) and lower stroke rates (0 vs. 7%, P = 0.009), compared with those who had no PVL. Patients with PVL were older, had lower BMI, higher prevalence of atrial fibrillation, higher brain natriuretic peptide (BNP), lower rest left ventricular ejection fraction, higher aortic cross-sectional area (Aa), lower stroke volume index, higher aortic resistance, stroke work, and higher energy loss index at rest and during dobutamine stress. Multivariable predictors of PVL post-TAVI were pre-procedural BNP levels and Aa.
  
  
  CONCLUSIONS
  PVL remains a common complication after TAVI, related to adverse events in LGSAS patients. Aa and BNP levels remain the most important predictors of PVL.
authors.affiliation: Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Chrysohoou
authors.affiliation: Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Hayek
authors.affiliation: Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Nick
authors.initials: N
authors.lastname: Spilias
authors.affiliation: Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA stam_lerakis@emoryhealthcare.org.
authors.forename: Stamatios
authors.initials: S
authors.lastname: Lerakis
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000401:mortality; D011475:Prosthesis Failure / Q000009:adverse effects*; D065467:Transcatheter Aortic Valve Replacement
keywords: Low gradient aortic stenosis; Paravalvular leak; TAVI