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Project properties

Title	Echocardiographic predictors of clinical outcomes after peecutaneous aortic valve replacement
Keywords	echocardiography aortic stenosis transcatheter aortic valve implantation
Researchers	dr. E. Lipsic Prof. dr. A.A. Voors J.J. Wykrzykowska
Nature of the research	Retrospective data collection on characteristics and clinical events and echocardiographic evaluation in >1000 patients who underwent percutaneous aortic valve replacement
Fields of study	cardiology

Background / introduction

Aortic Stenosis (AS) is one of the most common valvular heart diseases in the world. Its prevalence is increasing with age. A population-based study in the general population showed an prevalence of 0.7% (18-44 years old) to 13.3% (>75 years group). When left untreated, the prognosis of symptomatic aortic stenosis is poor. Without proper treatment, it leads to death within a couple of years after the first occurrence of symptoms. No medical treatment has shown to be effective. The therapy of choice has been surgical aortic valve replacement (SAVR) for a long time, improving the survival rate substantially. Nevertheless there is still a significant group of patients who are not eligible for SAVR because of the presence of comorbidities and older age. Rates are varying from 30 to 41%. For these patient, a transcatheter aortic valve implantation (TAVI) has become an attractive alternative. In this procedure, a bioprosthetic valve is implanted in the stenotic aortic valve through a catheter, making it less invasive than SAVR. A large multicenter randomized controlled trial reported a significant reduction of death at 1 year following a TAVI procedure compared with standard (surgical) therapy, 30.7% vs. 50.7%. Although the increased experience in the last decade resulted in a decrease in post-TAVI complications and a lower mortality rate, complications still occur. In the present proposal, we aim to study echocardiographic predictors pre-TAVI that can predict clinical outcome after TAVI. These data will support decision making and can improve selection of patients with the greatest benefit.

Research question / problem definition
What are the echocardiographic predictors of clinical outcome after a transcatheter aortic valve implantation?

Workplan

During the last decade, more than 1000 patients underwent a transcatheter aortic valve implantation (TAVI) in the UMCG. Data of these patients have been collected, but additional data on clinical characteristics, laboratory values and their long-term clinical outcome needs to be added for several patients. In addition, echocardiograms need to be uploaded and evaluated. The student will learn how to evaluate echocardiographic images by experienced echo technicians. Then, the student will apply statistical analyses (t-test, Chi2 regression analyses) on the data to address the primary research question. Finally, the student will write a report and potentially a scientific paper for an international journal on the outcomes of this study.

References

1. Carabello BA, Paulus WJ, Blase P, Carabello A. Aortic stenosis. Lancet [Internet]. 2009;373:956–66. Available from: www.thelancet.com
2. Ben-Dor I, Pichard AD, Gonzalez MA, Weissman G, Li Y, Goldstein SA, et al. Correlates and causes of death in patients with severe symptomatic aortic stenosis who are not eligible to participate in a clinical trial of transcatheter aortic valve implantation. Circulation. 2010;122(11 SUPPL. 1).
3. Khosravi A, Wendler O. TAVI 2018: from guidelines to practice. E-Journal Cardiol Pract. 2018;
4. Liu Z, Kidney E, Bem D, Bramley G, Bayliss S, De Belder MA, et al. Transcatheter aortic valve implantation for aortic stenosis in high surgical risk patients: A systematic review and meta-analysis. PLoS One. 2018 May 1;13(5).
5. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010 Oct 21;363(17):1597–607.
6. Généreux P, Webb JG, Svensson LG, Kodali SK, Satler LF, Fearon WF, et al. Vascular complications after transcatheter aortic valve replacement: Insights from the PARTNER (placement of AoRTic TraNscathetER valve) trial. J Am Coll Cardiol. 2012;60(12):1043–52.
7 Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695–705.
8 Makkar RR, Thourani VH, Mack MJ, Kodali SK, Kapadia S, Webb JG, et al. Five-Year Outcomes of Transcatheter or Surgical Aortic-Valve Replacement. N Engl J Med. 2020;382(9):799–809.

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