title: Aortic Valve Gradient and Clinical Outcome in Patients Undergoing Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis.
abstract: OBJECTIVE
  To explore the relation between the baseline aortic valve gradient (AVG) as a continuous variable and clinical outcomes following transcatheter aortic valve implantation (TAVI) in general and specifically in patients with high-gradient aortic stenosis (AS).
  
  
  METHODS
  We reviewed 317 consecutive patients who underwent TAVI at our institution. We investigated the relation between AVG as a continuous/categorical variable and outcome among all patients and in patients without low-flow low-gradient AS, using the Cox proportional hazard model adjusting for multiple prognostic variables.
  
  
  RESULTS
  Patients had a peak AVG of 79.9 ± 22.8 mm Hg (mean 50.5 ±15.7). During a mean follow-up of 2.7 years, AVG was inversely associated with mortality and mortality or cardiac hospitalization. Every 10-mm-Hg increase in peak AVG was associated with 18% reduction in mortality (p = 0.003) and 19% reduction in mortality/cardiac hospitalization (p < 0.001). Every 10-mm-Hg increase in mean AVG was associated with a 24% reduction in both outcomes (p = 0.005 and p < 0.001). Subgroup analysis of patients with left-ventricular ejection fraction >40% or peak AVG >64 mm Hg yielded similar results.
  
  
  CONCLUSIONS
  Mean and peak baseline AVGs are directly associated with improved outcomes after TAVI; AVG can be used to select the patients most likely to benefit from TAVI.
authors.affiliation: Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.
authors.forename: Guy
authors.initials: G
authors.lastname: Witberg
authors.forename: Alon
authors.initials: A
authors.lastname: Barsheshet
authors.forename: Abid
authors.initials: A
authors.lastname: Assali
authors.forename: Hana
authors.initials: H
authors.lastname: Vaknin-Assa
authors.forename: Aviv A
authors.initials: AA
authors.lastname: Shaul
authors.forename: Katia
authors.initials: K
authors.lastname: Orvin
authors.forename: Moti
authors.initials: M
authors.lastname: Vaturi
authors.forename: Shmuel
authors.initials: S
authors.lastname: Schwartzenberg
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shapira
authors.forename: Alexander
authors.initials: A
authors.lastname: Sagie
authors.forename: Ran
authors.initials: R
authors.lastname: Kornowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome; D016277:Ventricular Function, Left