New test can better predict long-term death risk after heart valve procedure

A simple test done during a minimally invasive heart valve replacement can predict a patient’s long-term risk of death, a group led by a University of Florida Health researcher has found.

The test involves pressure measurements within the heart following a transcatheter aortic valve replacement, or TAVR. The highly specialized procedure involves repairing a failing heart valve by inserting a functioning valve in its place. Many physicians record pressures inside the heart immediately after the procedure but as many as one-third do not obtain pressures. Patients who had abnormal intracardiac pressure were more than twice as likely to die within two years, the researchers determined.

The findings by researchers from UF Health and the Malcom Randall Veterans Affairs Medical Center in Gainesville were published today in the Journal of the American College of Cardiology: Cardiovascular Interventions.

A TAVR procedure is typically performed on patients who have a narrowed valve in the aorta, the main artery that carries blood away from the heart. It is also an alternative for those at high risk for standard, open-heart valve replacement surgery. There were nearly 50,000 TAVR procedures in the U.S. in 2017, and it is now more common than traditional heart valve surgery, according to the Society of Thoracic Surgeons.

To establish their findings, the researchers analyzed outcomes for 241 VA patients who underwent TAVR procedures between 2013 and 2018. Using blood pressure readings in the aorta and ventricle and the patient’s heart rate five to 10 minutes after a new aortic valve was inserted, the researchers calculated an index to determine whether intracardiac pressures were normal.

“We found that 22% of patients had abnormal intracardiac pressures. Patients who had abnormal intracardiac pressures experienced a doubling in the their long-term mortality,” said Anthony Bavry, M.D., an associate professor in the UF College of Medicine’s department of medicine and a cardiologist at the Malcom Randall VA Medical Center.

Bavry said he long believed that intracardiac pressure could be used to predict patient outcomes. But many physicians do not find merit in doing that.

“Obtaining intracardiac pressures after a TAVR procedure is valuable and more physicians should recognize this as a mechanism to potentially improve patient outcomes,” Bavry said.

While further research on the technique is needed, Bavry said having a simple, reliable test that can indicate a higher risk of death could help cardiologists optimize each patient’s treatment.

Next, Bavry and his colleagues are conducting a pilot study to determine if eplerenone, a medication used to treat high blood pressure as well as congestive heart failure after a heart attack, can benefit TAVR patients.