Mass to voltage ratio index predicts mortality following TAVI

Introduction: Transcatheter aortic valve replacement (TAVI) is an important therapeutic option in elderly patients with aortic stenosis. In this population, coexisting cardiac amyloidosis appears to be common and may affect prognosis. High LV mass index to QRS voltage may help identify AS patients with reduced prognosis prior to TAVI.

Material and method: This retrospective study enrolled consecutive patients who underwent TAVI in our institution between the years 2008-2019. Mass Voltage Ratio Index (MVRi) was calculated as the ratio of LV mass index on echocardiogram to voltage using the Sokolow-Lyon criteria on 12 lead ECG performed within 3 months prior to the intervention. The association between MVRi and mortality post TAVI was assessed.

Results and discussion: 251 patients (mean age 80.8 years, 49% men) were enrolled. 168 (67%) patients were alive at 3 years follow up. Analyzed as a continuous variable, MVRi was a statistically significant predictor of 3 year mortality (p < 0.005). Patients were divided into tertiles based on MVRi score (`low` – MVRi < 4.19, `middle`- 4.19 < MVRi < 6.58 and `high` – MVRi > 6.58). On univariate analysis the ‘high’ group had significantly higher 3 year mortality (p <0.001) compared to the other groups. In the multivariate model only Euroscore (p< 0.009) and MVRi (p < 0.011, OR 2.32; CI 1.15-4.964) were statistically significant predictors of mortality. The ‘high’ group had a significantly lower survival rate after 3 years follow up compared to other groups on Kaplan Meier analysis (p<0.001).

Conclusion: Our findings suggest that MVRi is a strong, independent predictor of increased post-TAVI mortality. This may be a simple clinical tool to assist in the assessment of patients prior to TAVI.