Calculated plasma volume status predicts outcomes after transcatheter aortic valve implantation

Annette Marie Maznyczka, Mohamad Barakat, Omar Aldalati, Mehdi Eskandari, Ann Wollaston, Vasileios Tzalamouras, Rafal Dworakowski, Ranjit Deshpande, Mark Monaghan, Jonathan Byrne, Olaf Wendler, Philip Maccarthy, Darlington Okonko*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

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.

Original languageEnglish
Article numbere001477
JournalOpen Heart
Volume7
Issue number2
DOIs
Publication statusPublished - 23 Dec 2020

Keywords

  • heart failure
  • heart valve diseases
  • transcatheter aortic valve replacement

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