title: Meta-Analysis of the Prognostic Impact of Stroke Volume, Gradient, and Ejection Fraction After Transcatheter Aortic Valve Implantation.
abstract: The prognostic implications of several baseline preprocedural variables in patients with severe native valve aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) are unclear. The goal of this study was to determine the impact of reduced stroke volume index (SVI), low gradient (LG), and reduced ejection fraction (EF) on all-cause mortality. We searched MEDLINE, CENTRAL, EMBASE, Web of Science, and Scopus through October 13, 2014. We evaluated the association between low SVI (<35 ml/m(2)), LG (<40 mm Hg), and low EF (<50% and <30%) on 1-year all-cause mortality. We pooled results across studies using the random-effects model. We included 16 studies at moderate risk of bias enrolling 7,673 patients with severe AS who underwent TAVI. Low EF was associated with increased 1-year mortality after TAVI compared to preserved EF (for EF <30%, hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.19 to 2.16, I(2) = 32%; and for EF <50%, HR 1.52, 95% CI 1.31 to 1.76, I(2) = 17%). LG was associated with increased mortality after TAVI compared to high mean gradient (≥40 mm Hg; HR 1.60, 95% CI 1.30 to 1.97, I(2) = 36%). Low SVI was associated with increased mortality after TAVI compared to normal SVI (HR 1.59, 95% CI 1.23 to 2.05, I(2) = 27%). In conclusion, low SVI, LG, and low EF are each associated with higher mortality after TAVI. These findings highlight the importance of including these variables into TAVI risk algorithms and will better inform shared decision-making before TAVI.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota. Electronic address: Eleid.mackram@mayo.edu.
authors.forename: Mackram F
authors.initials: MF
authors.lastname: Eleid
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Kashish
authors.initials: K
authors.lastname: Goel
authors.affiliation: Center for the Science of Health Care Delivery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Mayo Medical Library, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Rakesh M
authors.initials: RM
authors.lastname: Suri
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Rick A
authors.initials: RA
authors.lastname: Nishimura
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
mesh_terms: D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D011379:Prognosis; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology*