CT-defined prosthesis–patient mismatch downgrades frequency and severity, and demonstrates no association with adverse outcomes after transcatheter aortic valve replacement

John Mooney; Stephanie L. Sellers; Phillip Blanke; Philippe Pibarot; Rebecca T. Hahn; Danny Dvir; Pamela S. Douglas; Neil J. Weissman; Susheel K. Kodali; Vinod H. Thourani; Hasan Jilaihawi; Omar Khalique; Craig R. Smith; Shaw Hua Kueh; Mickael Ohana; Romi Grover; Christopher Naoum; Aaron Crowley; Wael A. Jaber; Maria C. Alu; Rupa Parvataneni; Michael Mack; John G. Webb; Martin B. Leon; Jonathon A. Leipsic

doi:10.1016/j.jcin.2017.05.031

CT-defined prosthesis–patient mismatch downgrades frequency and severity, and demonstrates no association with adverse outcomes after transcatheter aortic valve replacement

John Mooney, Stephanie L. Sellers, Phillip Blanke, Philippe Pibarot, Rebecca T. Hahn, Danny Dvir, Pamela S. Douglas, Neil J. Weissman, Susheel K. Kodali, Vinod H. Thourani, Hasan Jilaihawi, Omar Khalique, Craig R. Smith, Shaw Hua Kueh, Mickael Ohana, Romi Grover, Christopher Naoum, Aaron Crowley, Wael A. Jaber, Maria C. AluRupa Parvataneni, Michael Mack, John G. Webb, Martin B. Leon, Jonathon A. Leipsic^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

43 Citations (Scopus)

Abstract

Objectives: This study sought to determine if indexed effective orifice area (EOAi), using left ventricular outflow tract measured from computed tomography (EOAi_CT), reclassified prosthesis–patient mismatch (PPM) compared with conventional echocardiogram-defined measurements (EOAi_TTE).

Background: PPM does not predict mortality following transcatheter aortic valve replacement (TAVR). However, it is unknown if the EOAi_CT of the left ventricular outflow tract improves risk stratification.

Methods: A total of 765 TAVR patients from the PARTNER II (Placement of Aortic Transcatheter Valves II) trial S3i cohort were evaluated. EOAi was calculated using the continuity equation, and the left ventricular outflow tract area was derived from baseline computed tomography. Traditional echocardiographic categories defined PPM: absent (>0.85 cm²/m²), moderate (≥0.65 and ≤0.85 cm²/m²), or severe (≤0.65 cm²/m²). Correlation of EOAi_CT and EOAi_TTE to 1-year outcomes was performed.

Results: The incidence of PPM was 24% with EOA_CT compared with 45% with EOAi_TTE. Only 6% of PPM was graded severe by EOAi_CT compared with 9% by EOAi_TTE. EOAi_TTE, but not EOAi_CT, defined PPM showed association with reduced left ventricular mass regression (p = 0.03 vs. p = 0.52). There was no association between PPM and death or rehospitalization at 1 year with either modality. EOA_CT was associated with minor stroke at 1 year (log-rank p = 0.04), and EOAi_TTE with stroke/transient ischemic attack (log-rank p = 0.030). Furthermore, when subjects with mild or greater paravalvular regurgitation were excluded, the presence of PPM did not show association with any outcome.

Conclusions: EOAi_CT downgrades frequency and severity of PPM in patients after TAVR, and was not associated with mortality 1 year after TAVR. EOAi_TTE, but not EOAi_CT, was associated with less left ventricular mass regression.

Original language	English
Pages (from-to)	1578-1587
Number of pages	10
Journal	JACC: Cardiovascular Interventions
Volume	10
Issue number	15
DOIs	https://doi.org/10.1016/j.jcin.2017.05.031
Publication status	Published - 14 Aug 2017
Externally published	Yes

Keywords

CT
echocardiography
prosthesis–patient mismatch
transcatheter aortic valve replacement

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10.1016/j.jcin.2017.05.031

Cite this

Mooney, J., Sellers, S. L., Blanke, P., Pibarot, P., Hahn, R. T., Dvir, D., Douglas, P. S., Weissman, N. J., Kodali, S. K., Thourani, V. H., Jilaihawi, H., Khalique, O., Smith, C. R., Kueh, S. H., Ohana, M., Grover, R., Naoum, C., Crowley, A., Jaber, W. A., ... Leipsic, J. A. (2017). CT-defined prosthesis–patient mismatch downgrades frequency and severity, and demonstrates no association with adverse outcomes after transcatheter aortic valve replacement. JACC: Cardiovascular Interventions, 10(15), 1578-1587. https://doi.org/10.1016/j.jcin.2017.05.031

@article{b4952b69ba424f75883ff6f1f40e8540,

title = "CT-defined prosthesis–patient mismatch downgrades frequency and severity, and demonstrates no association with adverse outcomes after transcatheter aortic valve replacement",

abstract = "Objectives: This study sought to determine if indexed effective orifice area (EOAi), using left ventricular outflow tract measured from computed tomography (EOAiCT), reclassified prosthesis–patient mismatch (PPM) compared with conventional echocardiogram-defined measurements (EOAiTTE). Background: PPM does not predict mortality following transcatheter aortic valve replacement (TAVR). However, it is unknown if the EOAiCT of the left ventricular outflow tract improves risk stratification. Methods: A total of 765 TAVR patients from the PARTNER II (Placement of Aortic Transcatheter Valves II) trial S3i cohort were evaluated. EOAi was calculated using the continuity equation, and the left ventricular outflow tract area was derived from baseline computed tomography. Traditional echocardiographic categories defined PPM: absent (>0.85 cm2/m2), moderate (≥0.65 and ≤0.85 cm2/m2), or severe (≤0.65 cm2/m2). Correlation of EOAiCT and EOAiTTE to 1-year outcomes was performed. Results: The incidence of PPM was 24% with EOACT compared with 45% with EOAiTTE. Only 6% of PPM was graded severe by EOAiCT compared with 9% by EOAiTTE. EOAiTTE, but not EOAiCT, defined PPM showed association with reduced left ventricular mass regression (p = 0.03 vs. p = 0.52). There was no association between PPM and death or rehospitalization at 1 year with either modality. EOACT was associated with minor stroke at 1 year (log-rank p = 0.04), and EOAiTTE with stroke/transient ischemic attack (log-rank p = 0.030). Furthermore, when subjects with mild or greater paravalvular regurgitation were excluded, the presence of PPM did not show association with any outcome. Conclusions: EOAiCT downgrades frequency and severity of PPM in patients after TAVR, and was not associated with mortality 1 year after TAVR. EOAiTTE, but not EOAiCT, was associated with less left ventricular mass regression.",

keywords = "CT, echocardiography, prosthesis–patient mismatch, transcatheter aortic valve replacement",

author = "John Mooney and Sellers, {Stephanie L.} and Phillip Blanke and Philippe Pibarot and Hahn, {Rebecca T.} and Danny Dvir and Douglas, {Pamela S.} and Weissman, {Neil J.} and Kodali, {Susheel K.} and Thourani, {Vinod H.} and Hasan Jilaihawi and Omar Khalique and Smith, {Craig R.} and Kueh, {Shaw Hua} and Mickael Ohana and Romi Grover and Christopher Naoum and Aaron Crowley and Jaber, {Wael A.} and Alu, {Maria C.} and Rupa Parvataneni and Michael Mack and Webb, {John G.} and Leon, {Martin B.} and Leipsic, {Jonathon A.}",

year = "2017",

month = aug,

day = "14",

doi = "10.1016/j.jcin.2017.05.031",

language = "English",

volume = "10",

pages = "1578--1587",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier",

number = "15",

}

Mooney, J, Sellers, SL, Blanke, P, Pibarot, P, Hahn, RT, Dvir, D, Douglas, PS, Weissman, NJ, Kodali, SK, Thourani, VH, Jilaihawi, H, Khalique, O, Smith, CR, Kueh, SH, Ohana, M, Grover, R, Naoum, C, Crowley, A, Jaber, WA, Alu, MC, Parvataneni, R, Mack, M, Webb, JG, Leon, MB & Leipsic, JA 2017, 'CT-defined prosthesis–patient mismatch downgrades frequency and severity, and demonstrates no association with adverse outcomes after transcatheter aortic valve replacement', JACC: Cardiovascular Interventions, vol. 10, no. 15, pp. 1578-1587. https://doi.org/10.1016/j.jcin.2017.05.031

CT-defined prosthesis–patient mismatch downgrades frequency and severity, and demonstrates no association with adverse outcomes after transcatheter aortic valve replacement. / Mooney, John; Sellers, Stephanie L.; Blanke, Phillip et al.
In: JACC: Cardiovascular Interventions, Vol. 10, No. 15, 14.08.2017, p. 1578-1587.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - CT-defined prosthesis–patient mismatch downgrades frequency and severity, and demonstrates no association with adverse outcomes after transcatheter aortic valve replacement

AU - Mooney, John

AU - Sellers, Stephanie L.

AU - Blanke, Phillip

AU - Pibarot, Philippe

AU - Hahn, Rebecca T.

AU - Dvir, Danny

AU - Douglas, Pamela S.

AU - Weissman, Neil J.

AU - Kodali, Susheel K.

AU - Thourani, Vinod H.

AU - Jilaihawi, Hasan

AU - Khalique, Omar

AU - Smith, Craig R.

AU - Kueh, Shaw Hua

AU - Ohana, Mickael

AU - Grover, Romi

AU - Naoum, Christopher

AU - Crowley, Aaron

AU - Jaber, Wael A.

AU - Alu, Maria C.

AU - Parvataneni, Rupa

AU - Mack, Michael

AU - Webb, John G.

AU - Leon, Martin B.

AU - Leipsic, Jonathon A.

PY - 2017/8/14

Y1 - 2017/8/14

N2 - Objectives: This study sought to determine if indexed effective orifice area (EOAi), using left ventricular outflow tract measured from computed tomography (EOAiCT), reclassified prosthesis–patient mismatch (PPM) compared with conventional echocardiogram-defined measurements (EOAiTTE). Background: PPM does not predict mortality following transcatheter aortic valve replacement (TAVR). However, it is unknown if the EOAiCT of the left ventricular outflow tract improves risk stratification. Methods: A total of 765 TAVR patients from the PARTNER II (Placement of Aortic Transcatheter Valves II) trial S3i cohort were evaluated. EOAi was calculated using the continuity equation, and the left ventricular outflow tract area was derived from baseline computed tomography. Traditional echocardiographic categories defined PPM: absent (>0.85 cm2/m2), moderate (≥0.65 and ≤0.85 cm2/m2), or severe (≤0.65 cm2/m2). Correlation of EOAiCT and EOAiTTE to 1-year outcomes was performed. Results: The incidence of PPM was 24% with EOACT compared with 45% with EOAiTTE. Only 6% of PPM was graded severe by EOAiCT compared with 9% by EOAiTTE. EOAiTTE, but not EOAiCT, defined PPM showed association with reduced left ventricular mass regression (p = 0.03 vs. p = 0.52). There was no association between PPM and death or rehospitalization at 1 year with either modality. EOACT was associated with minor stroke at 1 year (log-rank p = 0.04), and EOAiTTE with stroke/transient ischemic attack (log-rank p = 0.030). Furthermore, when subjects with mild or greater paravalvular regurgitation were excluded, the presence of PPM did not show association with any outcome. Conclusions: EOAiCT downgrades frequency and severity of PPM in patients after TAVR, and was not associated with mortality 1 year after TAVR. EOAiTTE, but not EOAiCT, was associated with less left ventricular mass regression.

AB - Objectives: This study sought to determine if indexed effective orifice area (EOAi), using left ventricular outflow tract measured from computed tomography (EOAiCT), reclassified prosthesis–patient mismatch (PPM) compared with conventional echocardiogram-defined measurements (EOAiTTE). Background: PPM does not predict mortality following transcatheter aortic valve replacement (TAVR). However, it is unknown if the EOAiCT of the left ventricular outflow tract improves risk stratification. Methods: A total of 765 TAVR patients from the PARTNER II (Placement of Aortic Transcatheter Valves II) trial S3i cohort were evaluated. EOAi was calculated using the continuity equation, and the left ventricular outflow tract area was derived from baseline computed tomography. Traditional echocardiographic categories defined PPM: absent (>0.85 cm2/m2), moderate (≥0.65 and ≤0.85 cm2/m2), or severe (≤0.65 cm2/m2). Correlation of EOAiCT and EOAiTTE to 1-year outcomes was performed. Results: The incidence of PPM was 24% with EOACT compared with 45% with EOAiTTE. Only 6% of PPM was graded severe by EOAiCT compared with 9% by EOAiTTE. EOAiTTE, but not EOAiCT, defined PPM showed association with reduced left ventricular mass regression (p = 0.03 vs. p = 0.52). There was no association between PPM and death or rehospitalization at 1 year with either modality. EOACT was associated with minor stroke at 1 year (log-rank p = 0.04), and EOAiTTE with stroke/transient ischemic attack (log-rank p = 0.030). Furthermore, when subjects with mild or greater paravalvular regurgitation were excluded, the presence of PPM did not show association with any outcome. Conclusions: EOAiCT downgrades frequency and severity of PPM in patients after TAVR, and was not associated with mortality 1 year after TAVR. EOAiTTE, but not EOAiCT, was associated with less left ventricular mass regression.

KW - CT

KW - echocardiography

KW - prosthesis–patient mismatch

KW - transcatheter aortic valve replacement

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U2 - 10.1016/j.jcin.2017.05.031

DO - 10.1016/j.jcin.2017.05.031

M3 - Article

C2 - 28734891

AN - SCOPUS:85025454568

SN - 1936-8798

VL - 10

SP - 1578

EP - 1587

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 15

ER -

CT-defined prosthesis–patient mismatch downgrades frequency and severity, and demonstrates no association with adverse outcomes after transcatheter aortic valve replacement

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Keywords

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