Abstract 13038: A New Four-parameter Echocardiographic Score to Predict Mortality in Inoperable Aortic Stenosis Patients
Background: The Society of Thoracic Surgeons Predicted Risk of Mortality (STS) score is used to risk stratify patients for transcatheter aortic valve replacement (TAVR). However, calculation of the STS score requires compilation of 24 parameters. We examined the prognostic value of: 1) STS score alone; 2) STS score with various transthoracic echocardiographic (TTE) parameters; and 3) TTE parameters without STS score in predicting mortality in patients with severe aortic stenosis (AS) ineligible for surgical valve replacement.
Methods: Baseline demographics, TTE parameters, STS scores and clinical outcomes at an average follow-up of 1.8 years were obtained from 106 (40 male, 79+10 yrs) medically-managed inoperable patients with severe AS undergoing TTE from January 2007 to February 2012. TTE predictors of mortality were identified from univariate analyses. Hierarchical, multivariable Cox regression models were constructed. C-index was used to compare non-nested models.
Results: Overall mortality rate was 56%. Left atrial volume (LA Vol), E/E’, left ventricular ejection fraction (LVEF) and 4-chamber global longitudinal strain (4C-GLS) were significant univariable predictors of mortality. The combination of LA Vol, E/E’, LVEF and 4C-GLS provided a better predictive model than the STS score alone or in combination with TEE parameters (Figure).
Conclusions: Although STS score is an excellent predictor of mortality, the combination of LA Vol, E/E’, LVEF and 4C-GLS is superior. This 4-parameter TTE score offers a practical and easier alternative to the STS score in predicting mortality in inoperable AS patients.
- © 2013 by American Heart Association, Inc.