Impact of non-severe degenerative mitral stenosis on morbidity and mortality in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement - 07/06/19
, C. Selton-Suty 1, C. Venner 1, L. Fillipetti 1, N. Sadoul 1, Z. Lamiral 2, M. Kobayashi 2, N. Girerd 2, P. Maureira 3, Y. Juillière 1, B. Popovic 1, O. Huttin 1
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Résumé |
Introduction |
Severe degenerative mitral stenosis (DMS) is a known predictor of mortality in patients with symptomatic aortic stenosis (AS) considered for transcatheter aortic valve replacement (TAVR) but little data exist regarding mild to moderate DMS. We assessed the association of DMS with mitral annulus calcification (MAC) and evaluated the association of non-severe DMS and MAC with morbidity and mortality in patients with severe AS undergoing TAVR.
Method |
In a retrospective cohort of 346 patients with isolated severe AS undergoing TAVR, we evaluated the association of different DMS severities (based on transmitral mean pressure gradient (TMPG, mmHg)) and MAC severity with all-cause mortality and cardiovascular (CV) hospitalization/death. Severe DMS (TMPG>10mmHg) was excluded from the analysis.
Results |
Non-severe DMS (TMPG>2mmHg) was present in 42% of patients (n=147) and moderate to severe MAC in 46% (n=131). Patients with TMPG>2mmHg were predominantly female (66.7% vs. 41.7%, P<0.001) with a higher LVEF and smaller diastolic LV volume than patients with no DMS (P<0.05). In a multivariate analysis, TMPG (>2mmHg) and MAC (moderate to severe) were found to be independent predictors of mortality (HR=1.17 [1.02–1.35], P=0.0245 and HR=2.01 [1.18–3.44], P=0.01 respectively).
Conclusion |
Non-severe DMS is frequently associated with MAC in patients with severe AS undergoing TAVR. In the challenging context of DMS and MAC in patients undergoing TAVR, TMPG>2mmHg appears as an independent prognostic factor that discriminates high-risk patients.
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Vol 11 - N° 3
P. e311 - juin 2019 Retour au numéro
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