Calculated plasma volume status predicts outcomes after transcatheter aortic valve implantation

Maznyczka, A. M. et al. (2020) Calculated plasma volume status predicts outcomes after transcatheter aortic valve implantation. Open Heart, 7, e001477. (doi: 10.1136/openhrt-2020-001477) (PMID:33361316) (PMCID:PMC7759954)

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Abstract

Objectives: Congestion can worsen outcomes after transcatheter aortic valve implantation (TAVI), but can be difficult to quantify non-invasively. We hypothesised that preprocedural plasma volume status (PVS), estimated using a validated formula that enumerates percentage change from ideal PV, would provide prognostic utility post-TAVI. Methods: This retrospective cohort study identified patients who underwent TAVI (2007–2017) from a prospectively collected database. Actual ([1-haematocrit] × [a + (b × weight (Kg))] and ideal (c × weight (Kg)) PV were quantified from equations where a, b and c are sex-dependent constants. Calculated PVS was then derived (100% x [(actual – ideal PV)/ideal PV]). Results: In 564 patients (mean age 82±7 years, 49% male), mean PVS was −2.7±10.2%, with PV expansion (PVS >0%) evident in 39%. Only logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) independently predicted a PVS >0% (OR 1.85, p=0.002). On Cox analyses, a PVS >0% was associated with greater mortality at 3 (HR 2.29, 95% CI 1.11 to 4.74, p=0.03) and 12 months (HR 2.00, 95% CI 1.23 to 3.26, p=0.006) after TAVI, independently of, and incremental to, the EuroSCORE and New York Heart Association class. A PVS >0% was also independently associated with more days in intensive care (coefficient: 0.41, 95% CI 0.04 to 0.78, p=0.03) and in hospital (coefficient: 1.95, 95% CI 0.48 to 3.41, p=0.009). Conclusion: Higher PVS values, calculated simply from weight and haematocrit, are associated with greater mortality and longer hospitalisation post-TAVI. PVS could help refine risk stratification and further investigations into the utility of PVS-guided management in TAVI patients is warranted.

Item Type:Articles
Additional Information:AMM (FS/16/74/32573), DO (FS/14/77/30913) and MB (FS/14/77/30913) are supported by the British Heart Foundation. DO and MB are supported by the NIHR Biomedical Research Center at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Maznyczka, Dr Annette Marie
Authors: Maznyczka, A. M., Barakat, M., Aldalati, O., Eskandari, M., Wollaston, A., Tzalamouras, V., Dworakowski, R., Deshpande, R., Monaghan, M., Byrne, J., Wendler, O., MacCarthy, P., and Okonko, D.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Open Heart
Publisher:BMJ Publishing Group
ISSN:2053-3624
ISSN (Online):2053-3624
Copyright Holders:Copyright © 2020 The Authors
First Published:First published in Open Heart 7:e001477
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
174049T-TIME Coronary Physiology StudyColin BerryBritish Heart Foundation (BHF)FS/16/74/32573Institute of Cardiovascular & Medical Sciences