Outcome Prediction in Patients With Aortic Stenosis After TAVI

Aortic stenosis (AS), is a condition in which the aortic valve becomes narrowed as people get older, causing the heart pump (the left ventricle) to struggle to push blood through it, leading to breathlessness, chest pain and blackouts. If left untreated, the prognosis is bleak (similar to lung cancer). Previously the only effective treatment for AS was a valve replacement via open heart surgery, which was too high risk for many patients to undergo, meaning they were left without treatment. Over the last decade transcatheter aortic valve implantation (TAVI) has emerged as a treatment option for most patients with severe symptomatic AS. In TAVI, a new valve is inserted through a small tube, usually in the leg artery, which avoids open heart surgery.

Clinical outcomes after TAVI have significantly improved with the accumulation of operator and institution experience as well as the wide use of newer generation devices. However, a significant minority of patients undergoing TAVI derive little or no benefit from the procedure. Nearly a third describe no improvement in quality of life, or die within the first year. To combat this problem, it is essential we develop more sophisticated means of predicting adverse outcomes related to TAVI, to improve the selection of patients and identify patients where the potential benefit of the procedure is outweighed by unfavourable outcomes.

Assessment of physical recovery and improvement of symptoms and quality of life after TAVI is an important aspect of examining the outcomes of treatment. This is often a more meaningful and relevant treatment goal in the TAVI cohort than 'hard' clinical outcomes (like death and stroke) alone. Traditionally, less emphasis has been put on the assessment of the right side of the heart (the right ventricle) in evaluating physical recovery after TAVI.

We propose prospective observational study to evaluate the significance of the right side of the heart on the clinical outcomes related to functional recovery in patients undergoing TAVI.

• Change in New York Heart Association (NYHA) Functional Class [Срок оценки: Baseline to 3 months follow up]
• Change in N-terminal Prohormone of Brain Natriuretic Peptide (NT-proBNP Levels) [Срок оценки: Baseline to 3 months follow up]
• Change in right ventricular efficiency as measured by ventricular arterial coupling [Срок оценки: Baseline to immediately following intervention]
• Change in right ventricular strain/PASP coupling measure [Срок оценки: Baseline to immediately following intervention and 3 months follow up]
• Change in right ventricular end-systolic volume/stroke volume coupling measure [Срок оценки: Baseline to immediately following intervention and 3 months follow up]
• Change in right ventricular ejection fraction/PASP coupling measure [Срок оценки: Baseline to immediately following intervention and 3 months follow up]
• Change in right ventricular S'/PASP coupling measure [Срок оценки: Baseline to immediately following intervention and 3 months follow up]
• Change in Six Minute Walk Test (6MWT Distance or 6MWD) [Срок оценки: Baseline to 3 months follow up]
• Change in Quality of Life (QoL) as Measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) [Срок оценки: Baseline to 3 months follow up]