Clin Res Cardiol (2021)
DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Risk Prediction in Patients with Classical Low-Flow Low-Gradient Aortic Stenosis undergoing TAVR: the COLLAPSE Score
S. Ludwig1, A. Goßling1, M. Seiffert2, D. Westermann1, J.-M. Sinning3, A. Sugiura4, M. Adam5, V. Mauri5, D. Frank6, H. Seoudy6, L. Waldschmidt1, M. Linder1, S. Blankenberg7, H. Reichenspurner8, T. K. Rudolph9, M. Potratz9, L. Conradi8, N. Schofer1, für die Studiengruppe: HARbOR
1Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 2Klinik und Poliklinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 3Innere Medizin III - Kardiologie, St. Vinzenz-Hospital, Köln; 4Medizinische Klinik II - Kardiologie, Universitätsklinikum Bonn, Bonn; 5Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Köln; 6Klinik für Innere Medizin III, Schwerpunkt Kardiologie und Angiologie, Universitätsklinikum Schleswig-Holstein, Kiel; 7Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 8Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 9Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;

Objectives: Derivation and validation of a simple score system for risk prediction in patients with classical low-flow, low-gradient aortic stenosis (LFLG AS) undergoing transcatheter aortic valve replacement (TAVR).

 

Background: Data on outcome predictors in patients with LFLG AS are scarce. Yet, this patient subset suffers from particularly poor prognosis.

 

Methods: Among 9,150 patients undergoing TAVR (2008-2019) at five German high-volume centers, 717 patients with classical LFLG AS and sufficient computed tomography imaging for quantification of aortic valve calcification density (AVCd), were identified. The study cohort was divided into derivation (n=480) and validation (n=237) cohorts. Score variables were defined as independent predictors of mortality according to multivariable analysis in the derivation cohort. Validity of the score was assessed by Kaplan-Meier survival curves in the validation cohort as well as c-index and net reclassification improvement (NRI) compared to established risk estimation.

 

Results: Five independent predictors of mortality, according to multivariable analysis, were applied forming the COLLAPSE score: Chronic Obstructive puLmonary disease, Low AVCd, non-transfemoral Access, Pulmonary hypertension >55mmHg, Stroke volume indEx lower or equal 23.7 mL/m2 (Figure 1). Kaplan-Meier analysis showed lower 1-year mortality for patients with low (<2) versus high COLLAPSE score (more or equal 2) (25.9% vs. 40.3%, p=0.012) in the validation cohort. C-index for prediction of 1-year mortality was 0.61, resulting in a continuous NRI of 0.26 by using the COLLAPSE score compared to EuroSCORE II.

 

Conclusions: The COLLLAPSE score is based on simple clinical, echocardiographic and CT parameters and might serve as a helpful tool for risk prediction in patients with classical LFLG AS undergoing TAVR.
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