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

doi:10.1136/openhrt-2020-001477

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 journal › Article › peer-review

7 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 language	English
Article number	e001477
Journal	Open Heart
Volume	7
Issue number	2
DOIs	https://doi.org/10.1136/openhrt-2020-001477
Publication status	Published - 23 Dec 2020

Keywords

heart failure
heart valve diseases
transcatheter aortic valve replacement

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10.1136/openhrt-2020-001477

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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., & Okonko, D. (2020). Calculated plasma volume status predicts outcomes after transcatheter aortic valve implantation. Open Heart, 7(2), Article e001477. https://doi.org/10.1136/openhrt-2020-001477

@article{403d918292c247a7b24d5d9fb6666474,

title = "Calculated plasma volume status predicts outcomes after transcatheter aortic valve implantation",

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. ",

keywords = "heart failure, heart valve diseases, transcatheter aortic valve replacement",

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

year = "2020",

month = dec,

day = "23",

doi = "10.1136/openhrt-2020-001477",

language = "English",

volume = "7",

journal = "Open Heart",

issn = "2398-595X",

publisher = "BMJ Publishing Group",

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TY - JOUR

T1 - Calculated plasma volume status predicts outcomes after transcatheter aortic valve implantation

AU - Maznyczka, Annette Marie

AU - Barakat, Mohamad

AU - Aldalati, Omar

AU - Eskandari, Mehdi

AU - Wollaston, Ann

AU - Tzalamouras, Vasileios

AU - Dworakowski, Rafal

AU - Deshpande, Ranjit

AU - Monaghan, Mark

AU - Byrne, Jonathan

AU - Wendler, Olaf

AU - Maccarthy, Philip

AU - Okonko, Darlington

PY - 2020/12/23

Y1 - 2020/12/23

N2 - 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.

AB - 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.

KW - heart failure

KW - heart valve diseases

KW - transcatheter aortic valve replacement

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U2 - 10.1136/openhrt-2020-001477

DO - 10.1136/openhrt-2020-001477

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VL - 7

JO - Open Heart

JF - Open Heart

IS - 2

M1 - e001477

ER -

Calculated plasma volume status predicts outcomes after transcatheter aortic valve implantation

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