Stroke volume index and transvalvular flow rate trajectories in severe aortic stenosis treated with TAVR

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Abstract
The prognostic impact of flow trajectories according to stroke volume index (SVi) and transvalvular flow rate (FR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains poorly assessed. We evaluated and compared SVi and FR prior and after TAVR for severe AS. Patients were categorized according to SVi (2) and FR (P = 0.003) and similar to that in patients with normal baseline FR (P = 0.317). Baseline flow status was not an independent predictor of mid-term mortality among all-comers with severe AS undergoing TAVR. Flow recovery early after TAVR was frequent. Post-TAVR FR, but not SVi, was independently associated with mid-term all-cause mortality. By impacting flow status, AV replacement modifies the association of flow status with outcomes. Left top panel. Two parameters based on velocity-time integral calculation at the LV outflow tract have been proposed to assess flow status: (SVi, the ratio of stroke volume to BSA) and transvalvular flow rate (FR, the ratio of stroke volume to systolic ET). The pie chart describes the distribution of baseline FR and SVi in the study population. Right top panel. The bar graph depicts post-TAVR flow status according to SVi and FR in patients with pre-TAVR low flow. Lower panel. The Forest plot depicts the independent association (adjusted for demographics and in-study outcome predictors) of flow parameters pre- and post-TAVR with mid-term all-cause mortality. The Kaplan–Meier curve presents all-cause mortality stratified by post-TAVR flow status.

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