• Pradyumna Agasthi, Sai Harika Pujari, Farouk Mookadam, Andrew Tseng, Nithin R Venepally, Panwen Wang, Mohamed Allam, John Sweeney, Mackram Eleid, Floyd David Fortuin, David R Holmes, Nirat Beohar, and Reza Arsanjani.
• Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA. pradyumna_agasthi@hotmail.com.
• Yonsei Med. J. 2020 Jun 1; 61 (6): 482-491.

PurposeCardiac power (CP) index is a product of mean arterial pressure (MAP) and cardiac output (CO). In aortic stenosis, however, MAP is not reflective of true left ventricular (LV) afterload. We evaluated the utility of a gradient-adjusted CP (GCP) index in predicting survival after transcatheter aortic valve replacement (TAVR), compared to CP alone.Materials And MethodsWe included 975 patients who underwent TAVR with 1 year of follow-up. CP was calculated as (CO×MAP)/[451×body surface area (BSA)] (W/m²). GCP was calculated using augmented MAP by adding aortic valve mean gradient (AVMG) to systolic blood pressure (CP1), adding aortic valve maximal instantaneous gradient to systolic blood pressure (CP2), and adding AVMG to MAP (CP3). A multivariate Cox regression analysis was performed adjusting for baseline covariates. Receiver operator curves (ROC) for CP and GCP were calculated to predict survival after TAVR.ResultsThe mortality rate at 1 year was 16%. The mean age and AVMG of the survivors were 81±9 years and 43±4 mm Hg versus 80±9 years and 42±13 mm Hg in the deceased group. The proportions of female patients were similar in both groups (p=0.7). Both CP and GCP were independently associated with survival at 1 year. The area under ROCs for CP, CP1, CP2, and CP3 were 0.67 [95% confidence interval (CI), 0.62-0.72], 0.65 (95% CI, 0.60-0.70), 0.66 (95% CI, 0.61-0.71), and 0.63 (95% CI 0.58-0.68), respectively.ConclusionGCP did not improve the accuracy of predicting survival post TAVR at 1 year, compared to CP alone.© Copyright: Yonsei University College of Medicine 2020.

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