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  • Title: Changes in quality of life in patients with low-flow aortic stenosis undergoing transcatheter aortic valve replacement.
    Author: Ahmed A, Alsidawi S, Bae R, Cavalcante J, Fukui M, Gössl M, Sorajja P, Garcia S.
    Journal: Catheter Cardiovasc Interv; 2020 Oct 01; 96(4):972-978. PubMed ID: 32077618.
    Abstract:
    BACKGROUND: We sought to quantify and compare changes in quality of life measures after transcatheter aortic valve replacement (TAVR) in patients with low-flow (LF) and normal-flow (NF) aortic stenosis (AS). METHODS: We included 297 patients treated with TAVR at Abbott Northwestern Hospital from January 2015 to October 2017. Health status was assessed at baseline and 30 days post-procedure using the Kansas City Cardiomyopathy Questionnaire 12 (KCCQ-12). Overall (KCCQ-OS) and domain-specific (physical limitation, symptom frequency, quality of life, and social limitation) scores were compared in three subsets of patients as defined by stroke volume index (≤ or >35 ml/m2 ), ejection fraction (EF) (≤ or >40%), and mean gradient (≤ or >40 mmHg). RESULTS: Of the 297 patients included, 129 (43%) had NF high-gradient (NF AS group) and 168 (56%) had LF severe AS, including 25 (8%) with low EF (8%) ("Classical" low-flow low-gradient LEF [LF-LG-LEF] group) and 143 (48%) with preserved EF ("Paradoxical" LF-LG group). At baseline, patients with LF-LG-LEF AS had more severe impairment in symptoms frequency (p = .06) but similar KCCQ-OS. At 1-month after TAVR, all groups had moderate improvements in quality of life (Delta KCCQ-OS: "Classical" LF-LG-LEF 18 ± 21, paradoxical AS 14 ± 18, and NF AS 15 ± 16, p = .57). During a median follow-up time of 2.4 years, there was no difference in mortality (p = .34) but patients with paradoxical LF-LG AS had a higher risk of rehospitalization for heart failure (p = .01). CONCLUSIONS: Patients with LF severe AS derive significant improvements in quality of life measures after TAVR, indistinguishable from patients with NF AS.
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