A novel cardiovascular magnetic resonance risk score for predicting mortality following surgical aortic valve replacement

Vassilios S Vassiliou, Menelaos Pavlou, Tamir Malley, Brian P Halliday, Vasiliki Tsampasian, Claire E Raphael, Gary Tse, Miguel Silva Vieira, Dominique Auger, Russell Everett, Calvin Chin, Francisco Alpendurada, John Pepper, Dudley J Pennell, David E Newby, Andrew Jabbour, Marc R Dweck, Sanjay K Prasad, Vassilios S Vassiliou, Menelaos Pavlou, Tamir Malley, Brian P Halliday, Vasiliki Tsampasian, Claire E Raphael, Gary Tse, Miguel Silva Vieira, Dominique Auger, Russell Everett, Calvin Chin, Francisco Alpendurada, John Pepper, Dudley J Pennell, David E Newby, Andrew Jabbour, Marc R Dweck, Sanjay K Prasad

Abstract

The increasing prevalence of patients with aortic stenosis worldwide highlights a clinical need for improved and accurate prediction of clinical outcomes following surgery. We investigated patient demographic and cardiovascular magnetic resonance (CMR) characteristics to formulate a dedicated risk score estimating long-term survival following surgery. We recruited consecutive patients undergoing CMR with gadolinium administration prior to surgical aortic valve replacement from 2003 to 2016 in two UK centres. The outcome was overall mortality. A total of 250 patients were included (68 ± 12 years, male 185 (60%), with pre-operative mean aortic valve area 0.93 ± 0.32cm2, LVEF 62 ± 17%) and followed for 6.0 ± 3.3 years. Sixty-one deaths occurred, with 10-year mortality of 23.6%. Multivariable analysis showed that increasing age (HR 1.04, P = 0.005), use of antiplatelet therapy (HR 0.54, P = 0.027), presence of infarction or midwall late gadolinium enhancement (HR 1.52 and HR 2.14 respectively, combined P = 0.12), higher indexed left ventricular stroke volume (HR 0.98, P = 0.043) and higher left atrial ejection fraction (HR 0.98, P = 0.083) associated with mortality and developed a risk score with good discrimination. This is the first dedicated risk prediction score for patients with aortic stenosis undergoing surgical aortic valve replacement providing an individualised estimate for overall mortality. This model can help clinicians individualising medical and surgical care.Trial Registration ClinicalTrials.gov Identifier: NCT00930735 and ClinicalTrials.gov Identifier: NCT01755936.

Conflict of interest statement

Dr Vassiliou is an Editorial Board Member of Scientific Reports. Prof. Pennell has received research funding from Siemens and La Jolla; has served as a consultant to Bayer; and is a director of and shareholder in CVIS. Prof. Prasad has received honoraria for talks from Bayer Schering. All others authors declare no conflict of interest.

© 2021. The Author(s).

Figures

Figure 1
Figure 1
Kaplan–Meier estimator plot of survival in patients with no gadolinium enhancement, midwall enhancement and infarction pattern enhancement. This plot indicates significantly worse prognosis in the patients with either form of enhancement (midwall or infarction) out to 10 years (log rank P = 0.029). Patients with a mixed pattern of LGE were categorized according to the predominant pattern of fibrosis.
Figure 2
Figure 2
Observed vs predicted risk of mortality for patients following SAVR. The observed (black) vs predicted (grey) risk of mortality for patients following SAVR out to 10 years in clinically relevant risk groups is shown, indicating good prediction for the model. Number of patients per risk group: 73, 94, 42 and 41 for risk groups 1, 2, 3 and 4, respectively.

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