Open AccessRisk Prediction in Aortic Valve Replacement: Incremental Value of the Preoperative Echocardiogram
Author(s) -
Tan Timothy C.,
Flynn Aidan W.,
ChenTournoux Annabel,
Rudski Lawrence G.,
Mehrotra Praveen,
Nunes Maria C.,
Rincon Luis M.,
Shahian David M.,
Picard Michael H.,
Afilalo Jonathan
Publication year - 2015
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.115.002129
Subject(s) - medicine , cardiology , aortic valve replacement , cohort , logistic regression , stenosis , diastole , left atrial enlargement , aortic valve , blood pressure , atrial fibrillation , sinus rhythm
Background Risk prediction is a critical step in patient selection for aortic valve replacement ( AVR ), yet existing risk scores incorporate very few echocardiographic parameters. We sought to evaluate the incremental predictive value of a complete echocardiogram to identify high‐risk surgical candidates before AVR . Methods and Results A cohort of patients with severe aortic stenosis undergoing surgical AVR with or without coronary bypass was assembled at 2 tertiary centers. Preoperative echocardiograms were reviewed by independent observers to quantify chamber size/function and valve function. Patient databases were queried to extract clinical data. The cohort consisted of 432 patients with a mean age of 73.5 years and 38.7% females. Multivariable logistic regression revealed 3 echocardiographic predictors of in‐hospital mortality or major morbidity: E/e’ ratio reflective of elevated left ventricular (LV) filling pressure; myocardial performance index reflective of right ventricular (RV) dysfunction; and small LV end‐diastolic cavity size. Addition of these echocardiographic parameters to the STS risk score led to an integrated discrimination improvement of 4.1% ( P <0.0001). After a median follow‐up of 2 years, Cox regression revealed 5 echocardiographic predictors of all‐cause mortality: small LV end‐diastolic cavity size; LV mass index; mitral regurgitation grade; right atrial area index; and mean aortic gradient <40 mm Hg. Conclusions Echocardiographic measures of LV diastolic dysfunction and RV performance add incremental value to the STS risk score and should be integrated in prediction when evaluating the risk of AVR . In addition, findings of small hypertrophied LV cavities and/or low mean aortic gradients confer a higher risk of 2‐year mortality.