title: Prognostic impact of invasive haemodynamic measurements in combination with clinical and echocardiographic characteristics on two-year clinical outcomes of patients undergoing transcatheter aortic valve implantation.
abstract: OBJECTIVE
  The aim of the study was to evaluate the prognostic utility of right heart catheterisation (RHC)-derived measures among patients undergoing transcatheter aortic valve implantation (TAVI).
  
  
  RESULTS
  Data of 469 patients included in the Bern TAVI Registry between August 2007 and December 2012 and undergoing preoperative RHC were analysed. The relationship between haemodynamic parameters and survival was evaluated with Cox proportional hazards models. At two-year follow-up, 118 patients had died (25.1%). At multivariable analysis, diabetes (hazard ratio [HR] 1.95, 95% confidence interval [CI]: 1.28-2.96, p=0.001), transapical access (HR 1.66, 95% CI: 1.07-2.56, p=0.02), and moderate or severe mitral regurgitation (HR 1.55, 95% CI: 1.00-2.39, p=0.04) were independent predictors of two-year mortality, whereas no correlation between RHC-derived measures and mortality was found. Furthermore, the addition of haemodynamic variables did not significantly improve the prognostic power of a model incorporating clinical and echocardiographic data (Harrell's C-index: 0.667, 95% CI: 0.615-0.719 vs. 0.662, 95% CI: 0.612-0.713, p=0.47).
  
  
  CONCLUSIONS
  On the basis of a comprehensive clinical and echocardiographic evaluation, RHC performed prior to TAVI does not add incremental prognostic value.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland.
authors.forename: Anna
authors.initials: A
authors.lastname: Franzone
authors.forename: Crochan J
authors.initials: CJ
authors.lastname: O'Sullivan
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.forename: Dik
authors.initials: D
authors.lastname: Heg
authors.forename: Jonas
authors.initials: J
authors.lastname: Lanz
authors.forename: René
authors.initials: R
authors.lastname: Vollenbroich
authors.forename: Fabien
authors.initials: F
authors.lastname: Praz
authors.forename: Raffaele
authors.initials: R
authors.lastname: Piccolo
authors.forename: Masahiko
authors.initials: M
authors.lastname: Asami
authors.forename: Eva
authors.initials: E
authors.lastname: Roost
authors.forename: Lorenz
authors.initials: L
authors.lastname: Räber
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*