Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Prognostic impact of the Get-With-The-Guidelines Heart-Failure risk score (GWTG-HF) after transcatheter aortic valve replacement in patients with low-flow low-gradient aortic valve stenosis
C. Eckel1, J. Blumenstein1, O. Husser2, C. Grothusen1, H. Al-Terki1, M. U. Becher3, H. Möllmann1, V. Tiyerili1
1Klinik für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund; 2Innere Medizin - Kardiologie, Klinik Augustinum München, München; 3Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn;

Objectives:

This single center study examines the prognostic value of the get-with-the-guidelines heart-failure risk score (GWTG-HF) for mortality after transcatheter aortic valve implantation (TAVR) in patients with low-flow-low-gradient aortic valve stenosis (LFLG-AS).

 

Background:

Data on feasibility of TAVR and mortality prediction in the LFLG-AS population are scarce.

 

Methods:

A total of 212 treated patients with real LFLG-AS were enrolled. Patients were divided in low (< 45; n = 128) and high risk ( 45; n = 84) group for calculated GWTG-HF score and followed up for 1 year with clinical outcomes assessed at discharge and 1 year for cardiovascular events (VARC-2) and composite endpoints.

 

Results:

Mean age was 79.5 [76.0;82.2] vs. 83.0 [80.0;85.0] (p=<0.001) with 47 (36.7%) vs. 26 (31.0%) female (p=0.474), median logistic euroscore of 17.3 [12.3;25.0] vs. 24.8 [17.4;38.5] (p=<0.001) and mean indexed stroke volume of 28.0 [23.0;32.0] vs. 25.0 [20.8;28.8](p=0.004). The groups differed at follow-up in terms of all-cause mortality (10.7 vs. 35.2%; HR 3.31; CI 95% 1.64-6.70; p<0.001) and the composite endpoint of death and hospitalization for heart failure (18.3 vs. 36.4%, HR 2.26, p=0.015) see figure 1. There was no difference in intrahospital event rate (VARC). Hemodynamically, there was no difference in mean gradients (7.0 [5.0;9.0] vs. 7.0 [5.0;8.0], p=0.216) or aortic valve area (1.9 [1.6;2.2] vs. 1.7 [1.5;2.1], p=0.151). Rate of device failure (6.3 % vs. 8.6% %, p=0.729) did not vary. 

 

Conclusions:

The GWTG score is suited to predict mortality after transcatheter heart valve implantation in LFLG-AS subgroup. Both groups show similar intrahospital event and mortality rate, independent for calculated mortality risk. The high-risk population shows higher mortality and an increased composite for mortality and hospitalization for heart failure at 1-year follow-up. 

Figure 1:


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