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Energy Loss Index as a Predictor of All-Cause Mortality after Transcatheter Aortic Valve Replacement: A 9-year follow-up
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  • Gurkaran Johal,
  • Vinesh Jonnala,
  • Leili Pourafkari,
  • Siavash Sedghi,
  • Samira Jafarsis,
  • Stanley Fernandez,
  • Vijay Iyer,
  • Nader Nader
Gurkaran Johal
University at Buffalo Jacobs School of Medicine and Biomedical Sciences

Corresponding Author:gurkaran@buffalo.edu

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Vinesh Jonnala
Rutgers University Newark
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Leili Pourafkari
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Siavash Sedghi
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Samira Jafarsis
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Stanley Fernandez
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Vijay Iyer
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Nader Nader
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Abstract

Background: As transcatheter aortic valve replacement (TAVR) procedures become more widely available, there is a growing need to monitor and evaluate postoperative outcomes accurately. The energy loss index (ELI) of the ascending aorta has been commonly used to examine the agreement between the echocardiographic and Gorlin measurement of the aortic valve area. Objectives: This project aims to demonstrate a link between ELI values and mortality following implanted TAVR valves and determine an ELI cutoff value associated with post-TAVR events. Method: We retrospectively reviewed patients undergoing TAVR from 2012 – 2017. We calculated ELI values for patients immediately postoperative after a TAVR procedure. Using Receiver-Operator Characteristic and Cox Regression analyses, we identified a cutoff value to distinguish between high and low-risk patients. Results: This study showed ELI ≤ 1.34 (hazard ratio, 1.783; 95% confidence interval 1.231-2.583, p=0.002) as representative of patients with a high risk of mortality post-TAVR. Additionally, post-TAVR, ejection fraction increased by 3.5 percent (p<0.001), and the aortic valve effective orifice area increased by 1.25 cm squared (p<0.001) while the mean transvalvular gradient decreased by 33.6 mmHg (p<0.001) and the peak transvalvular gradient decreased by 49.7 mmHg (p<0.001). Conclusion: ELI is an additional prognostic factor that should be considered during risk assessment before TAVR. This study shows that patients with ELI ≤ 1.34 had decreased cumulative survival post-TAVR. These patients had a fivefold increased risk of death following TAVR.
12 Aug 2022Submitted to Echocardiography
12 Aug 2022Assigned to Editor
12 Aug 2022Submission Checks Completed
16 Aug 2022Reviewer(s) Assigned
23 Nov 2022Review(s) Completed, Editorial Evaluation Pending
05 Dec 2022Editorial Decision: Revise Major