Introduction
Material & methods
Study population
Transthoracic echocardiography
TAVR
Statistical analysis
Results
Study cohort and baseline characteristics
Total | Men | Women | P value | |
---|---|---|---|---|
No. (%) | ||||
Total | 303 (100.0) | 151 (49.8) | 152 (50.2) | 0.991 |
Age | ||||
60–69 | 6 (2.0) | 5 (3.3.) | 1 (0.7) | 0.097 |
70–79 | 70 (23.1) | 35 (23.2) | 35 (23.0) | 0.975 |
80–89 | 209 (69.0) | 102 (67.5) | 107 (70.4) | 0.592 |
≥ 90 | 18 (5.9) | 9 (6.0) | 9 (5.9) | 0.988 |
BMI | ||||
< 18.5 | 3 (1.0) | 2 (1.3) | 1 (0.6) | 0.591 |
18.5–24.9 | 135 (44.6) | 65 (43.0) | 70 (46.1) | 0.466 |
25.0–29.9 | 108 (35.6) | 62 (41.1) | 46 (30.3) | 0.015 |
30.0–34.9 | 42 (13.9) | 16 (10.6) | 26 (17.1) | 0.061 |
35.0–39.9 | 14 (4.6) | 6 (4.0) | 8 (5.3) | 0.521 |
≥ 40.0 | 1 (0.3) | 0 (0.0) | 1 (0.6) | 0.305 |
NYHA ≥ III | 163 (53.8) | 73 (48.3) | 90 (58.9) | 0.135 |
Diabetes mellitus | 74 (24.4) | 33 (21.9) | 41 (27.0) | 0.300 |
Arterial hypertension | 248 (81.8) | 120 (79.5) | 128 (84.2) | 0.284 |
CVD | 208 (68.6) | 111 (73.5) | 97 (63.8) | 0.097 |
Previous myocardial infarction | 13 (4.3) | 4 (2.6) | 9 (5.9) | 0.156 |
Atrial fibrillation | 104 (34.3) | 60 (39.7) | 44 (28.9) | 0.048 |
Previous cardiac surgery | 17 (5.6) | 12 (7.9) | 5 (3.3) | 0.078 |
Pacemaker (before TAVR) | 18 (5.9) | 11 (7.3) | 7 (4.6) | 0.324 |
Malignancy | 58 (19.1) | 35 (23.2) | 23 (15.1) | 0.075 |
Stroke (before TAVR) | 23 (7.6) | 12 (7.9) | 11 (7.2) | 0.790 |
PAOD | 19 (6.3) | 6 (4.0) | 13 (8.6) | 0.100 |
COPD | 43 (14.2) | 25 (16.6) | 18 (11.8) | 0.240 |
COPD Gold 1 | 27 (8.9) | 17 (11.3) | 10 (6.6) | 0.153 |
COPD Gold 2 | 11 (3.6) | 5 (3.3) | 6 (3.9) | 0.767 |
COPD Gold 3 | 5 (1.7) | 3 (2.0) | 2 (1.3) | 0.647 |
COPD Gold 4 | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1.000 |
LVEF | ||||
≤ 40 | 33 (10.9) | 24 (15.9) | 9 (5.9) | 0.007 |
41–49 | 24 (7.9) | 12 (7.9) | 12 (7.9) | 0.483 |
≥ 50 | 246 (81.2) | 115 (76.2) | 131 (86.2) | 0.090 |
HfpEF | 94 | 39 | 55 | 0.238 |
sPAP | ||||
≥ 40 | 142 (46.9) | 74 (49.0) | 68 (44.7) | 0.456 |
≥ 50 | 75 (24.8) | 38 (25.2) | 37 (24.3) | 0.868 |
< 35 | 123 (40.6) | 61 (40.4) | 62 (40.8) | 0.945 |
35–50 | 123 (40.6) | 56 (37.1) | 67 (44.1) | 0.215 |
51–70 | 45 (14.9) | 26 (17.2) | 19 (12.5) | 0.248 |
> 70 | 12 (4.0) | 8 (5.3) | 4 (2.6) | 0.234 |
AVI ≥ II° | 54 (17.9) | 22 (14.6) | 32 (21.1) | 0.164 |
MVI ≥ II° | 78 (25.8) | 36 (23.8) | 42 (27.6) | 0.354 |
TVI ≥ II° | 59 (19.5) | 25 (16.6) | 34 (22.4) | 0.204 |
Pacemaker (after TAVR) | 69 (22.8) | 45 (29.8) | 24 (15.8) | 0.004 |
Vascular complications | 23 (7.6) | 12 (7.9) | 11 (7.2) | 0.815 |
Stroke (after TAVR) | 9 (3.0) | 4 (2.6) | 5 (3.3) | 0.743 |
Mean ± SD | ||||
Age (years) | 82.6 ± 4.8 | 82.6 ± 5.2 | 82.6 ± 4.4 | 0.911 |
Height (cm) | 166.9 ± 8.7 | 172.9 ± 6.4 | 160.7 ± 6.0 | < 0.001 |
Weight (kg) | 73.8 ± 14.4 | 78.2 ± 12.8 | 69.2 ± 14.6 | < 0.001 |
BMI (kg/m2) | 26.4 ± 4.9 | 26.1 ± 4.0 | 26.8 ± 5.8 | 0.288 |
eGFR CKD-EPI (ml/min/1.73m2) | 62.5 ± 17.3 | 64.8 ± 17.9 | 60.7 ± 19.4 | 0.187 |
LVEF (%) | 55.0 ± 10.3 | 53.5 ± 11.5 | 56.6 ± 8.7 | 0.009 |
LVEDD (mm) | 43.6 ± 17.2 | 45.0 ± 18.6 | 42.1 ± 15.5 | 0.270 |
IVSd (mm) | 14.5 ± 3.0 | 14.8 ± 3.4 | 14.2 ± 2.5 | 0.143 |
AV Vmax (m/s) | 4.4 ± 0.9 | 4.4 ± 1.0 | 4.3 ± 0.7 | 0.386 |
AV dpmax (mmHg) | 79.0 ± 19.0 | 79.5 ± 17.9 | 78.5 ± 20.1 | 0.653 |
AV dpmean (mmHg) | 48.1 ± 12.0 | 48.0 ± 11.3 | 48.2 ± 12.6 | 0.889 |
TAPSE (mm) | 22.1 ± 4.4 | 22.4 ± 4.5 | 21.7 ± 4.3 | 0.320 |
sPAP (mmHg) | 37.1 ± 19.1 | 38.8 ± 19.1 | 35.5 ± 18.9 | 0.123 |
Median ± IQR | ||||
STS score | 2.8 ± 1.9 | 2.1 ± 1.3 | 3.4 ± 2.2 | < 0.001 |
Creatinine (mg/dl) | 1.0 ± 0.4 | 1.1 ± 0.40 | 0.9 ± 0.4 | 0.003 |
BNP (pg/ml) | 1443.0 ± 2460.5 | 1918.0 ± 3460.7 | 1240.0 ± 1643.4 | 0.127 |
HK (%) | 38.0 ± 6.4 | 39.1 ± 6.9 | 37.4 ± 6.0 | 0.002 |
HB (g/dl) | 12.7 ± 2.3 | 13.4 ± 2.4 | 12.4 ± 1.9 | < 0.001 |
CK (U/l) | 76.0 ± 61.5 | 79.0 ± 69.0 | 73.5 ± 51.8 | 0.069 |
Short- and long-term survival regarding gender
Short- and long-term survival regarding sPAP
sPAP-dependent mortality risk factors after TAVR
Cox regression analysis | Univariate | Multivariate | ||
---|---|---|---|---|
Hazard ratio (95% CI) | p value | Hazard ratio (95% CI) | p value | |
1-year mortality sPAP ≥ 40 mmHg | ||||
Gender (male) | 5.477 (1.879–15.965) | 0.002 | 9.546 (2.218–41.096) | 0.002 |
Height | 1.676 (1.091–2.577) | 0.019 | 1.026 (0.458–2.295) | 0.951 |
Weight | 1.589 (1.078–2.342) | 0.019 | 1.082 (0.659–1.776) | 0.755 |
Previous cardiac surgery | 5.823 (2.179–15.560) | < 0.001 | 3.863 (1.291–11.555) | 0.016 |
Stroke (before TAVR) | 2.464 (0.845–7.183) | 0.099 | 2.048 (0.575–7.296) | 0.269 |
LVEF | 0.695 (0.514–0.940) | 0.018 | 0.858 (0.548–1.344) | 0.504 |
AV dpmax | 0.704 (0.479–1.034) | 0.074 | 0.885 (0.331–2.364) | 0.808 |
AV dpmean | 0.672 (0.436–1.036) | 0.072 | 0.707 (0.439–1.137) | 0.152 |
Pacemaker (after TAVR) | 1.996 (0.882–4.518) | 0.097 | 1.942 (0.798–4.727) | 0.144 |
1-year mortality sPAP ≥ 50 mmHg | ||||
Gender (male) | 5.885 (1.701–20.356) | 0.005 | 77.954 (5.268–1153.475) | 0.002 |
Height | 1.697 (1.043–2.763) | 0.033 | 0.973 (0.234–4.048) | 0.970 |
Weight | 1.704 (1.014–2.862) | 0.044 | 1.183 (0.536–2.611) | 0.677 |
Previous myocardial infarction | 5.259 (1.195–23.142) | 0.028 | 34.232 (4.152–282.267) | 0.001 |
Atrial fibrillation | 0.311 (0.102–0.946) | 0.040 | 0.282 (0.067–1.191) | 0.085 |
Previous cardiac surgery | 5.567 (1.970–15.730) | 0.001 | 0.721 (0.127–4.089) | 0.712 |
AV Vmax | 0.331 (0.148–0.737) | 0.007 | 1.557 (0.011–230.508) | 0.862 |
AV dpmax | 0.700 (0.480–1.022) | 0.065 | 0.394 (0.215–0.721) | 0.003 |
AV dpmean | 0.645 (0.407–1.020) | 0.061 | 0.850 (0.292–2.476) | 0.766 |
TVI ≥ II° | 0.282 (0.082–0.973) | 0.045 | 1.323 (0.196–8.928) | 0.774 |
Pacemaker (after TAVR) | 2.986 (1.154–7.728) | 0.024 | 8.723 (2.135–35.644) | 0.003 |
Cox regression analysis | Univariate | Multivariate | ||
---|---|---|---|---|
Hazard ratio (95% CI) | p value | Hazard ratio (95% CI) | p value | |
3-year mortality sPAP ≥ 40 mmHg | ||||
Gender (male) | 4.007 (1.911–8.401) | < 0.001 | 4.210 (1.843–9.618) | 0.001 |
Height | 1.525 (1.095–2.124) | 0.012 | 0.771 (0.470–1.264) | 0.302 |
Weight | 1.333 (0.972–1.829) | 0.074 | 1.001 (0.660–1.517) | 0.998 |
Previous cardiac surgery | 7.137 (3.095–16.455) | < 0.001 | 5.231 (2.143–12.769) | < 0.001 |
LVEF | 0.743 (0.580–0.951) | 0.019 | 0.976 (0.720–1.324) | 0.877 |
AV dpmean | 0.759 (0.550–1.048) | 0.094 | 0.828 (0.600–1.143) | 0.251 |
3-year mortality sPAP ≥ 50 mmHg | ||||
Gender (male) | 4.303 (1.724–10.740) | 0.002 | 17.035 (3.857–75.246) | < 0.001 |
Height | 1.432 (0.958–2.139) | 0.080 | 0.687 (0.377–1.251) | 0.219 |
Previous myocardial infarction | 3.722 (0.874–15.860) | 0.076 | 21.218 (3.294–136.692) | 0.001 |
Atrial fibrillation | 0.464 (0.202–1.069) | 0.071 | 0.727 (0.395–1.338) | 0.306 |
Previous cardiac surgery | 5.768 (2.263–14.702) | < 0.001 | 2.958 (0.801–10.917) | 0.104 |
AV Vmax | 0.401 (0.201–0.799) | 0.009 | 0.313 (0.144–0.678) | 0.003 |
TVI ≥ II° | 0.401 (0.161–1.000) | 0.050 | 0.800 (0.269–2.379) | 0.688 |
Pacemaker (after TAVR) | 2.293 (0.993–5.294) | 0.052 | 5.517 (1.873–16.254) | 0.002 |
Cox regression analysis | Univariate | Multivariate | ||
---|---|---|---|---|
Hazard ratio (95% CI) | p value | Hazard ratio (95% CI) | p value | |
5-year mortality sPAP ≥ 40 mmHg | ||||
Gender (male) | 2.350 (1.401–3.942) | 0.001 | 2.555 (1.416–4.613) | 0.002 |
Height | 1.257 (0.970–1.629) | 0.084 | 0.726 (0.486–1.085) | 0.119 |
Previous cardiac surgery | 5.482 (2.452–12.257) | < 0.001 | 8.431 (3.200–22.212) | < 0.001 |
LVEF | 0.800 (0.651–0.982) | 0.033 | 0.841 (0.657–1.077) | 0.170 |
AV dpmax | 0.785 (0.605–1.020) | 0.070 | 0.755 (0.537–1.061) | 0.106 |
Stroke (after TAVR) | 3.579 (0.865–14.811) | 0.078 | 2.397 (0.402–14.306) | 0.338 |
5-year mortality sPAP ≥ 50 mmHg | ||||
Gender (male) | 2.455 (1.240–4.861) | 0.010 | 7.609 (2.857–20.268) | < 0.001 |
Previous myocardial infarction | 5.623 (1.680–18.815) | 0.005 | 16.235 (3.596–73.300) | < 0.001 |
Atrial fibrillation | 0.441 (0.217–0.896) | 0.024 | 0.384 (0.156–0.942) | 0.037 |
Previous cardiac surgery | 4.579 (1.864–11.247) | 0.001 | 2.128 (0.570–7.950) | 0.262 |
AV Vmax | 0.452 (0.241–0.846) | 0.013 | 0.962 (0.293–3.162) | 0.949 |
AV dpmax | 0.736 (0.552–0.981) | 0.037 | 0.524 (0.377–0.729) | < 0.001 |
Pacemaker (after TAVR) | 2.071 (0.996–4.307) | 0.051 | 4.413 (1.766–11.030) | 0.001 |
Short- and long-term survival regarding sPAP and gender
Gender-dependent mortality risk factors after TAVR
Cox regression analysis | Univariate | Multivariate | ||
---|---|---|---|---|
Hazard ratio (95% CI) | p value | Hazard ratio (95% CI) | p value | |
1-year mortality male | ||||
sPAP | 2.041 (1.410–2.953) | < 0.001 | 2.310 (1.568–3.402) | < 0.001 |
Stroke (after TAVR) | 3.522 (0.832–14.919) | 0.087 | 12.609 (2.496–63.708) | 0.002 |
1-year mortality female | ||||
HK | 0.564 (0.312–1.019) | 0.058 | 0.621 (0.317–1.217) | 0.165 |
HB | 0.565 (0.309–1.034) | 0.064 | 1.643 (0.162–16.628) | 0.674 |
CK | 1.243 (1.087–1.420) | 0.001 | 1.265 (1.103–1.450) | 0.001 |
Pacemaker (after TAVR) | 3.350 (0.980–11.449) | 0.054 | 3.134 (0.779 –12.611) | 0.108 |
3-year mortality male | ||||
sPAP | 1.871 (1.392–2.516) | < 0.001 | 1.774 (1.293–2.432) | < 0.001 |
BNP | 1.227 (1.001–1.504) | 0.049 | 0.982 (0.754–1.278) | 0.890 |
HB | 0.782 (0.583–1.048) | 0.099 | 0.991 (0.680–1.444) | 0.962 |
3-year mortality female | ||||
STS score | 1.654 (0.922–2.966) | 0.091 | 1.507 (0.716–3.169) | 0.280 |
LVEF | 0.694 (0.461–1.045) | 0.080 | 0.622 (0.229–1.690) | 0.352 |
CK | 1.243 (1.089–1.420) | 0.001 | 12.169 (1.020–145.170) | 0.048 |
5-year mortality male | ||||
Age | 1.257 (0.980–1.612) | 0.072 | 1.061 (0.764–1.473) | 0.730 |
STS score | 1.473 (0.991–2.190) | 0.055 | 0.994 (0.456–2.167) | 0.988 |
sPAP | 1.612 (1.258–2.065) | < 0.001 | 1.405 (0.945–2.088) | 0.093 |
BNP | 1.233 (1.027–1.482) | 0.025 | 0.854 (0.558–1.308) | 0.469 |
HK | 0.782 (0.609–1.004) | 0.054 | 0.877 (0.258–2.976) | 0.833 |
HB | 0.791 (0.619–1.010) | 0.060 | 0.818 (0.515–1.301) | 0.396 |
5-year mortality female | ||||
Previous cardiac surgery | 3.116 (0.968–10.026) | 0.057 | 2.911 (0.866–9.789) | 0.084 |
IVSd | 1.334 (0.967–1.840) | 0.079 | 1.351 (0.961–1.899) | 0.083 |
CK | 1.240 (1.084–1.418) | 0.002 | 1.269 (1.101–1.463) | 0.001 |
Stroke (after TAVR) | 4.805 (1.891–12.209) | 0.001 | 6.751 (2.327–19.591) | < 0.001 |