Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Hatz,D.
Predictive value of invasively determined hemodynamic parameters regarding post-procedural prognosis in patients undergoing transcatheter aortic valve implantation
Humanmedizin; [Diplomarbeit] Medical University of Graz;2019. pp. 59
[OPEN ACCESS]
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Rainer Peter
- Altmetrics:
- Abstract:
- Introduction With TAVI becoming popular throughout Europe it has been applied not only in high-risk but also in intermediate-risk patients. It now bears the necessity to find diagnostic tools to create individual patient risk stratification towards the outcome. The aim of this study is to find a hemodynamic parameter, which is predictive in regards to the 1-year mortality. Methods In a retrospective study, data from originally 554 subjects, who have undergone a TAVI, have been reviewed and analyzed descriptively and with regression analysis, in terms of population demographics, comorbidities and hemodynamic parameters. 375 subjects meeting the inclusion criteria were analyzed in a multivariable COX-regression model, focusing on significance in parameters regarding the 1-year-mortality. Results The all-cause 1-year mortality rate of the entire study population was 11.6 %. Hemodynamic values analyzed univariably showed a statistical significance (aortic mean pressure gradient (p = 0.005), diastolic pulmonary artery pressure (p = 0.029), right atrial pressure (p = 0.002). Peripheral vascular disease (p < 0.001), chronic obstructive pulmonary disease (p = 0.028) and estimated glomerular filtration rate (p = 0.037) as well as right atrial pressure (p = 0.007) showed to be strongly significant in univariable analysis as well as in multivariable analysis. Conclusion Overall, this study was able to show a significant association between the right atrial pressure and the 1-year mortality rate after TAVI. Therefore, the RAP could act as predictive value in TAVI outcome. However, considering the study’s limitations, the accuracy of the measurement itself, as well as being the first study to accomplish this finding, needs to be considered. According to the outcome of the study, besides right atrial pressure, right heart catheterization could not establish any further significant results in regards to survival, since values pulmonary pressures have shown no statistical evidence. The results were partially concordant with findings from previous studies, confirming that chronic obstructive pulmonary disease, peripheral vascular disease and kidney function act as predictor regarding 1-year mortality. Further research needs to be committed in order to determine whether RAP can be used as predictive value in TAVI patients.