@article{10902/29990,
year = {2023},
url = {https://hdl.handle.net/10902/29990},
abstract = {Background: A non-negligible rate of patients undergoing transcatheter aortic valve replacement (TAVR) do not report symptomatic improvement or even die in the short-midterm. We sought to assess the degree of objective functional recovery after TAVR and its prognostic implications and to develop a predictive model. Methods: In a cohort of patients undergoing TAVR, a prospective evaluation of clinical, anatomical, and physiological parameters was conducted before and after the procedure. These parameters were derived from echocardiography, non-invasive analysis of arterial pulse waves, and cardiac tomography. Objective functional improvement 6 months after TAVR was assessed using a 6-min walk test and nitro-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The derived predictive model was prospectively validated in a different cohort. A clinical follow-up was conducted at 2 years. Results: Among the 212 patients included, objective functional improvement was observed in 169 patients (80%) and subjective improvement in 187 (88%). Patients with objective functional improvement showed a much lower death rate at 2 years (9% vs. 31% p = 0.0002). Independent predictors of improvement were as follows: mean aortic gradient of ≥40 mmHg, augmentation index75 of ≥45%, the posterior wall thickness of ≤12 mm, and absence of atrial fibrillation. A simple integer-based point score was developed (GAPA score), which showed an area under the curve of 0.81 for the overall cohort and 0.78 for the low-gradient subgroup. In a validation cohort of 216 patients, these values were 0.75 and 0.76, respectively.
Conclusion: A total of 80% of patients experienced objective functional improvement after TAVR, showing a significantly lower 2-year mortality rate. A predictive score was built that showed a good discriminative performance in overall and low-gradient populations},
organization = {Funding: This project was partially supported by an unrestricted grant from MIT (Massachusetts Institute of Technology)-Spain “La Caixa” Foundation seed fund (code LCF/PR/MIT17/11820006). 
Acknowledgments: We thank the MIT-Spain “La Caixa” Foundation seed fund for the support provided to facilitate collaboration with the Edelman Lab in the IMES group at MIT. We also sincerely thank professor Mercedes Balcells, from the same institute, for her key role in making this collaboration possible},
publisher = {Frontiers Media S.A.},
publisher = {Frontiers in Cardiovascular Medicine, 2023, 10, 1118409},
title = {A new integrative approach to assess aortic stenosis burden and predict objective functional improvement after TAVR},
author = {Torre Hernández, José María de la and Ben-Assa, Eyal and Sainz Laso, Fermín and Lee, Dae-Hyun and Ruisánchez Villar, Cristina and Lerena Sáenz, Piedad Idoia and García Camarero, Tamara and Cuesta Cosgaya, José María and Fradejas Sastre, Víctor and Benito, Mercedes and Barrera, Sergio and García Unzueta, María Teresa and Brown, Jonathan and Gil Ongay, Aritz and Zueco, Javier and Vázquez de Prada Tiffe, José Antonio and Edelman, Elazar R. and Veiga Fernández, Gabriela},
}