Predictores e impacto pronóstico de la insuficiencia cardiaca tras el implante percutáneo de válvula aórtica con una prótesis autoexpandible

espanolIntroduccion y objetivos El objetivo es analizar la incidencia, los predictores y el impacto pronostico de la insuficiencia cardiaca (IC) aguda tras el implante percutaneo de una valvula aortica (TAVI) con una protesis autoexpandible. Metodos Desde 2008, se incluye prospectivamente en nuestro registro de TAVI a todos los pacientes sometidos a TAVI en nuestro centro. Se analizan los factores pronosticos determinantes de IC aguda, y la relacion con la mortalidad mediante modelos de regresion de Cox. Resultados Se sometieron a TAVI 399 pacientes, con una media de edad de 82,4 ± 5,8 anos, de los que 213 (53,4%) eran mujeres. Durante el seguimiento (27,0 ± 24,1 meses), el 29,8% de los pacientes (n = 119) ingresaron en el hospital con el diagnostico de IC aguda, lo que representa una incidencia anual del 13,2% (IC95%, 11,1-15,8%). Al final del seguimiento, habian fallecido 150 pacientes (37,59%). En el grupo de IC aguda se evidencio una tasa de mortalidad significativamente mayor (el 52,1 frente al 31,4%; HR = 1,84; IC95%, 1,14-2,97; p Conclusiones El TAVI se asocia con una alta incidencia de eventos de IC aguda, lo que supone un gran impacto en la mortalidad. La IC aguda previa al implante y la puntuacion de la Society of Thoracic Surgeons fueron los unicos predictores de IC aguda hallados. Un indice de riesgo nutricional bajo y la enfermedad pulmonar obstructiva cronica son potentes determinantes de mortalidad en el grupo de IC aguda. EnglishIntroduction and objectives The purpose of this analysis was to assess the incidence, predictors and prognostic impact of acute heart failure (AHF) after transcatheter aortic valve implantation (TAVI) using a self-expanding prosthesis. Methods From November 2008 to June 2017, all consecutive patients undergoing TAVI in our center were prospectively included in our TAVI registry. The predictive effect of AHF on all-cause mortality following the TAVI procedure was analyzed using Cox regression models. Results A total of 399 patients underwent TAVI with a mean age of 82.4 ± 5.8 years, of which 213 (53.4%) were women. During follow-up (27.0 ± 24.1 months), 29.8% (n = 119) were admitted due to AHF, which represents a cumulative incidence function of 13.2% (95%CI, 11.1%-15.8%). At the end of follow-up, 150 patients (37.59%) had died. Those who developed AHF showed a significantly higher mortality rate (52.1% vs 31.4%; HR, 1.84; 95%CI, 1.14-2.97; P = .012). Independent predictors of AHF after TAVI were a past history of heart failure (P = .019) and high Society of Thoracic Surgeons score (P = .004). We found that nutritional risk index and chronic obstructive pulmonary disease were strongly correlated with outcomes in the AHF group. Conclusions TAVI was associated with a high incidence of clinical AHF. Those who developed AHF had higher mortality. Pre-TAVI AHF and high Society of Thoracic Surgeons score were the only independent predictors of AHF in our cohort. A low nutritional risk index and chronic obstructive pulmonary disease were independent markers of mortality in the AHF group.