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Original research
Left ventricular filling pressure and survival following aortic valve replacement for severe aortic stenosis
  1. Jeremy J Thaden1,
  2. Mahesh Balakrishnan1,
  3. Jose Sanchez1,
  4. Rosalyn Adigun1,
  5. Vuyisile T Nkomo1,
  6. Mackram Eleid1,
  7. Jordi Dahl1,
  8. Christopher Scott2,
  9. Sorin Pislaru1,
  10. Jae K Oh1,
  11. Hartzell Schaff3,
  12. Patricia A Pellikka1
  1. 1 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Jeremy J Thaden, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; thaden.jeremy{at}mayo.edu

Abstract

Objective To determine whether echocardiography-derived left ventricular filling pressure influences survival in patients with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR).

Methods We retrospectively reviewed 1383 consecutive patients with severe AS, normal ejection fraction and interpretable filling pressure undergoing AVR. Left ventricular filling pressure was determined according to current guidelines using mitral inflow, mitral annular tissue Doppler, estimated right ventricular systolic pressure and left atrial volume index. Cox proportional hazards regression was used to assess the influence of various parameters on mortality.

Results Age was 75±10 years and 552 (40%) were female. Left ventricular filling pressure was normal in 325 (23%), indeterminate in 463 (33%) and increased in 595 (43%). Mean follow-up was 7.3±3.7 years, and mortality was 1.2%, 4.2% and 18.9% at 30 days and 1 and 5 years, respectively. Compared with patients with normal filling pressure, patients with increased filling pressure were older (78±9 vs 70±12, p<0.001), more often female (45% vs 35%, p=0.002) and were more likely to have New York Heart Association class III–IV symptoms (35% vs 24%, p=0.004), coronary artery disease (55% vs 42%, p<0.001) and concentric left ventricular hypertrophy (63% vs 37%, p<0.001). After correction for other factors, increased left ventricular filling pressure remained an independent predictor of mortality after successful AVR (adjusted HR 1.45 (95% CI 1.16 to 1.81), p=0.005).

Conclusions Preoperative increased left ventricular filling pressure is common in patients with AS undergoing AVR and has important prognostic implications, regardless of symptom status. Future prospective studies should consider whether patients with increased filling pressure would benefit from earlier operation.

  • aortic stenosis
  • echocardiography
  • valve disease surgery
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Footnotes

  • Twitter @pattypellikka

  • Contributors JJT: study planning, data analysis, manuscript writing and review. MB: study planning, data acquisition and analysis. JS and ROA: study planning, data acquisition, and analysis. VTN, MFE, SVP, JKO, HVS and PAP: study design and critical review of the manuscript. JD: data acquisition, analysis and critical review of the manuscript. CS: data acquisition and analysis.

  • Funding This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under award number R01AG034676.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Mayo Clinic Institutional Review Board. Informed consent was waived, given the retrospective nature of this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data available from corresponding author upon reasonable request.

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