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Anatomic Stenosis Severity as a Prognostic Marker in Patients With Low-Flow Low-Gradient Aortic Stenosis Undergoing TAVI (ATLAS TAVI)
AnaTomic Stenosis Severity Derived From Computed Tomography as a Prognostic Marker in Patients With Low-flow Low-gradient Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation
Studie Overzicht
Toestand
Gedetailleerde beschrijving
Aortic valve calcification (AVC) as assessed by MSCT is highly correlated with aortic stenosis (AS) severity and, thus, has become an important tool for diagnosing severe AS, especially in patients with low-flow low-gradient aortic stenosis (LFLG AS). Moreover, in medically treated AS patients AVC is directly associated with poor prognosis. In contrast, the prognostic benefit of eliminating AS by Transcatheter Aortic Valve Implantation (TAVI) in patients with LFLG AS seems to be larger in patients with high AVC density (AVCd) compared to those with low AVCd, at least in "classical" (low EF) LFLG AS. Hence, we hypothesize that AVCd might be a valuable marker for treatment response among TAVI patients with LFLG AS, who are known to suffer from poor outcome even after elimination of AS.
The multicentric ATLAS TAVI Registry of LFLG AS patients, who underwent TAVI, assesses the impact of AVCd on outcome in these patients.
Studietype
Inschrijving (Verwacht)
Contacten en locaties
Studiecontact
- Naam: Niklas Schofer, MD
- Telefoonnummer: +49-40-7410-0
- E-mail: n.schofer@uke.de
Studie Locaties
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Montréal, Canada
- Werving
- Montreal Heart Institute
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Contact:
- Walid Ben Ali, MD
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Québec, Canada
- Werving
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval
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Contact:
- Marie-Annick Clavel, PhD
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Odense, Denemarken
- Werving
- Odense University Hospital
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Contact:
- Jordi Dahl, MD
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Bad Nauheim, Duitsland
- Werving
- Kerckhoff-Klinik
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Contact:
- Won K Kim, MD
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Hamburg, Duitsland
- Werving
- University Heart and Vascular Center Hamburg
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Leipzig, Duitsland
- Werving
- Heart Center Leipzig
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Contact:
- Mohamed Abdel-Wahab, MD
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Lille, Frankrijk
- Werving
- CHU de Lille
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Contact:
- Augustin Coisne, MD
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Paris, Frankrijk
- Werving
- Hôpital Bichat - Claude-Bernard
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Contact:
- Marina Urena Alcazar, MD
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Petah Tikva, Israël
- Werving
- Rabin Medical Center
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Contact:
- Uri Landes, MD
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Rotterdam, Nederland
- Werving
- Erasmus University Medical Centre
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Contact:
- Nicolas van Mieghem, MD
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Edinburgh, Verenigd Koninkrijk
- Werving
- University of Edinburgh
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Contact:
- Mark Dweck, MD
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
Accepteert gezonde vrijwilligers
Geslachten die in aanmerking komen voor studie
Bemonsteringsmethode
Studie Bevolking
Beschrijving
Inclusion Criteria:
- age ≥18 years
- patient gave written informed consent for data acquisition and transfer
- for LFLG AS: -- available non-contrast MSCT data on aortic valve calcification (AVC, Agatston Units)
Exclusion Criteria:
- LFLG AS without non-contrast MSCT data on AVC
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
Cohorten en interventies
Groep / Cohort |
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Classical Low-Flow, Low-Gradient Aortic Stenosis
Classical Low-Flow, Low-Gradient Aortic Stenosis is defined as valve area <1 cm2, mean gradient <40 mmHg, ejection fraction <50% and stroke volume index (SVi) ≤35 mL/m2 by resting transthoracic echocardiography.
Dobutamine stress echocardiography is not mandatory for the definition of classical LFLG AS.
All patients in this subgroup underwent TAVI and have available data on aortic valve calcification.
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Paradoxical Low-Flow, Low-Gradient Aortic Stenosis
Paradoxical Low-Flow, Low-Gradient Aortic Stenosis is defined as valve area <1 cm2, mean gradient <40 mmHg, ejection fraction ≥50% and SVi ≤35 mL/m2 by resting transthoracic echocardiography.
All patients in this subgroup underwent TAVI and have available data on aortic valve calcification.
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High-Gradient Aortic Stenosis (Control group)
High-Gradient Aortic Stenosis is defined as valve area <1 cm2 and mean gradient >40 mmHg by resting transthoracic echocardiography.
All patients in this subgroup underwent TAVI.
Data on aortic valve calcification is not mandatory for this control group.
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Conservative treatment (Control group)
The subgroup includes all patients with (severe or non-severe) aortic stenosis, who underwent conservative treatment.
Data on aortic valve calcification is not mandatory for this control group.
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Tijdsspanne |
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Sterfte door alle oorzaken
Tijdsspanne: 12 maanden
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12 maanden
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Cardiovascular Mortality
Tijdsspanne: 12 months
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Incidence of cardiovascular death, defined as death attributable to myocardial ischemia and infarction, heart failure, cardiac arrest because of other or unknown cause, or cerebrovascular accident.
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12 months
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Rehospitalizations for congestive heart failure
Tijdsspanne: 12 months
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Incidence of new-onset or worsening signs and symptoms of heart failure that required urgent therapy and resulted in hospitalization, e.g. as assessed by patient interviews or hospital records.
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12 months
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Medewerkers en onderzoekers
Onderzoekers
- Hoofdonderzoeker: Marie-Annick Clavel, PhD, Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
- Hoofdonderzoeker: Niklas Schofer, MD, University Heart and Vascular Center Hamburg, Hamburg, Germany
- Hoofdonderzoeker: Sebastian Ludwig, MD, University Heart and Vascular Center Hamburg, Hamburg, Germany
Publicaties en nuttige links
Algemene publicaties
- Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Munoz D, Rosenhek R, Sjogren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL; ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017 Sep 21;38(36):2739-2791. doi: 10.1093/eurheartj/ehx391. No abstract available.
- Cueff C, Serfaty JM, Cimadevilla C, Laissy JP, Himbert D, Tubach F, Duval X, Iung B, Enriquez-Sarano M, Vahanian A, Messika-Zeitoun D. Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart. 2011 May;97(9):721-6. doi: 10.1136/hrt.2010.198853. Epub 2010 Aug 18.
- Clavel MA, Messika-Zeitoun D, Pibarot P, Aggarwal SR, Malouf J, Araoz PA, Michelena HI, Cueff C, Larose E, Capoulade R, Vahanian A, Enriquez-Sarano M. The complex nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study. J Am Coll Cardiol. 2013 Dec 17;62(24):2329-38. doi: 10.1016/j.jacc.2013.08.1621. Epub 2013 Sep 24.
- Clavel MA, Pibarot P, Messika-Zeitoun D, Capoulade R, Malouf J, Aggarval S, Araoz PA, Michelena HI, Cueff C, Larose E, Miller JD, Vahanian A, Enriquez-Sarano M. Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol. 2014 Sep 23;64(12):1202-13. doi: 10.1016/j.jacc.2014.05.066.
- Ludwig S, Gossling A, Waldschmidt L, Linder M, Bhadra OD, Voigtlander L, Schafer A, Deuschl F, Schirmer J, Reichenspurner H, Blankenberg S, Schafer U, Westermann D, Seiffert M, Conradi L, Schofer N. TAVR for low-flow, low-gradient aortic stenosis: Prognostic impact of aortic valve calcification. Am Heart J. 2020 Jul;225:138-148. doi: 10.1016/j.ahj.2020.03.013. Epub 2020 Apr 8.
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Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
Andere studie-ID-nummers
- ATLAS TAVI
Plan Individuele Deelnemersgegevens (IPD)
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