Abstract
Balloon aortic valvuloplasty (BAV) has been a therapeutic alternative treatment for severe symptomatic aortic stenosis. Previous studies have been unable to predict 1-year outcome because of limited acute and follow-up clinical, invasive and echocardiographic data. The purpose of this study was to predict long-term outcome based on comprehensive data obtained at the time of valvuloplasty and at 3 and 6 months after the procedure. Of 170 consecutive patients undergoing BAV, 108 (mean age 78 years) were at least 1 year from their procedure. Prospective clinical, micromanometer hemodynamic, digital ventriculographic and echocardiographic/ Doppler data were collected at baseline and immediately after the procedure. Echocardiographic data were also obtained at 3 and 6 months. With use of Cox model analysis, major events (defined as cardiac death [n = 30], aortic valve replacement [n = 21] or repeat BAV [n = 13]) were predicted by advanced age, baseline heart failure class, and baseline echocardiographic-determined diastolic left ventricular diameter. Only baseline left ventricular ejection fraction proved to be a significant predictor of cardiac death (p = 0.002) in a multivariate model. Absolute values after BAV (stroke work, first derivative of left ventricular pressure, valve area, end-systolic volume, Fick cardiac output, transvalvular gradient) and acute changes measured by catheterization or echocardiography did not provide additional predictive information over that of postprocedure ejection fraction. Similarly, echocardiographic valve area and transvalvular gradient at 3 months added no further prognostic data. With an ejection fraction ≥ 45% (n = 63), cardiac survival at 1 year was 80%, irrespective of age, sex, congestive heart failure class or severity of coronary artery disease. Thus, prognosis after BAV can be determined by noninvasive clinical and echocardiographic data obtained before cardiac catheterization. Despite advanced age and concomitant medical problems, patients undergoing BAV with baseline ejection fractions ≥ 45% have an excellent cardiac survival to 1 year.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 75-80 |
| Number of pages | 6 |
| Journal | The American journal of cardiology |
| Volume | 68 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 1 1991 |
Funding
alloon aortic valvuloplasty (BAV) has been an alternative treatment for severe aortic steno-B &L-~ Although restenosisa nd recurrent symp-toms occur often at a variable time after the procedure, some patients experience sustained improvement.l -l 2 Previous studies have describeds hort-term predictors of outcome, based on either invasive or noninvasive pa-rameters.3-7H owever, analysis of factors predictive of long-term outcome have yet to be delineated. In an el-derly and debilitated population of patients, BAV often representst he only treatment option other than medical therapy. Therefore, it becomesi mportant lo clarify its role in the treatment of symptomatic aortic stenosis. Controversy exists as to what factors, if any, consti-tute a successfulp rocedure (e.g., final aortic valve area, and changesi n aortic or echocardiographic valve areas 1 to 3 days after BAV).3-7 Previous studies have limit-ed long-term data and have typically failed to analyze both invasive, hemodynamic and serial echocardio-graphic data and their relation to patient outcome. Prospective determination of clinical, hemodynamic or From Duke University Medical Center, Department of Medicine, Divi- echocardiographic variables predictive of 1-year out-in part by Grant 5T32 HL07 101f rom the National Institutes of Health, sion of Cardiology, Durham, North Carolina. This study was supported come would help clarify the patient groups that are National Research Service Award, Bethesda, Maryland. Manuscript likely to benefit from BAV. This study identifies the received January 15, 1991; revised manuscript received March 13, clinical, acute hemodynamic and echocardiographic Address for reprints: Charles J. Davidson, MD, Duke University 1991,a nd acceptedM arch 17. variables that predict l-year outcome after BAV, and Medical Center, Department of Medicine, Division of Cardiology, Box determines whether 3-or &month echocardiographic 3 1195,D urham, North Carolina 2771 0. data provide additional prognostic information.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine