Anatomic Stenosis Severity as a Prognostic Marker in Patients With Low-Flow Low-Gradient Aortic Stenosis Undergoing TAVI

NCT ID: NCT04914481

Last Updated: 2021-06-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

1500 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-04-01

Study Completion Date

2025-12-31

Brief Summary

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The ATLAS TAVI Registry is a retrospective, investigator-initiated, multicenter registry including patients, who underwent Transcatheter Aortic Valve Implantation (TAVI) for classical or paradoxical low-flow, low-gradient aortic stenosis (LFLG AS) with available non-contrast MSCT data on aortic valve calcification (AVC). The main objective of this study is the assessment of outcome after TAVI according to AVC density severity in patients with LFLG AS.

Detailed Description

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Aortic valve calcification (AVC) as assessed by MSCT is highly correlated with aortic stenosis (AS) severity and, thus, has become an important tool for diagnosing severe AS, especially in patients with low-flow low-gradient aortic stenosis (LFLG AS). Moreover, in medically treated AS patients AVC is directly associated with poor prognosis. In contrast, the prognostic benefit of eliminating AS by Transcatheter Aortic Valve Implantation (TAVI) in patients with LFLG AS seems to be larger in patients with high AVC density (AVCd) compared to those with low AVCd, at least in "classical" (low EF) LFLG AS. Hence, we hypothesize that AVCd might be a valuable marker for treatment response among TAVI patients with LFLG AS, who are known to suffer from poor outcome even after elimination of AS.

The multicentric ATLAS TAVI Registry of LFLG AS patients, who underwent TAVI, assesses the impact of AVCd on outcome in these patients.

Conditions

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Low-Flow, Low-Gradient Aortic Stenosis

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Classical Low-Flow, Low-Gradient Aortic Stenosis

Classical Low-Flow, Low-Gradient Aortic Stenosis is defined as valve area \<1 cm2, mean gradient \<40 mmHg, ejection fraction \<50% and stroke volume index (SVi) ≤35 mL/m2 by resting transthoracic echocardiography. Dobutamine stress echocardiography is not mandatory for the definition of classical LFLG AS. All patients in this subgroup underwent TAVI and have available data on aortic valve calcification.

No interventions assigned to this group

Paradoxical Low-Flow, Low-Gradient Aortic Stenosis

Paradoxical Low-Flow, Low-Gradient Aortic Stenosis is defined as valve area \<1 cm2, mean gradient \<40 mmHg, ejection fraction ≥50% and SVi ≤35 mL/m2 by resting transthoracic echocardiography. All patients in this subgroup underwent TAVI and have available data on aortic valve calcification.

No interventions assigned to this group

High-Gradient Aortic Stenosis (Control group)

High-Gradient Aortic Stenosis is defined as valve area \<1 cm2 and mean gradient \>40 mmHg by resting transthoracic echocardiography. All patients in this subgroup underwent TAVI. Data on aortic valve calcification is not mandatory for this control group.

No interventions assigned to this group

Conservative treatment (Control group)

The subgroup includes all patients with (severe or non-severe) aortic stenosis, who underwent conservative treatment. Data on aortic valve calcification is not mandatory for this control group.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* age ≥18 years
* patient gave written informed consent for data acquisition and transfer
* for LFLG AS: -- available non-contrast MSCT data on aortic valve calcification (AVC, Agatston Units)

Exclusion Criteria

\- LFLG AS without non-contrast MSCT data on AVC
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Institut universitaire de cardiologie et de pneumologie de Québec, University Laval

OTHER

Sponsor Role collaborator

Universitätsklinikum Hamburg-Eppendorf

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Marie-Annick Clavel, PhD

Role: PRINCIPAL_INVESTIGATOR

Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada

Niklas Schofer, MD

Role: PRINCIPAL_INVESTIGATOR

University Heart and Vascular Center Hamburg, Hamburg, Germany

Sebastian Ludwig, MD

Role: PRINCIPAL_INVESTIGATOR

University Heart and Vascular Center Hamburg, Hamburg, Germany

Locations

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Montreal Heart Institute

Montreal, , Canada

Site Status RECRUITING

Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval

Québec, , Canada

Site Status RECRUITING

Odense University Hospital

Odense, , Denmark

Site Status RECRUITING

CHU de Lille

Lille, , France

Site Status RECRUITING

Hôpital Bichat - Claude-Bernard

Paris, , France

Site Status RECRUITING

Kerckhoff-Klinik

Bad Nauheim, , Germany

Site Status RECRUITING

University Heart and Vascular Center Hamburg

Hamburg, , Germany

Site Status RECRUITING

Heart Center Leipzig

Leipzig, , Germany

Site Status RECRUITING

Rabin Medical Center

Petah Tikva, , Israel

Site Status RECRUITING

Erasmus University Medical Centre

Rotterdam, , Netherlands

Site Status RECRUITING

University of Edinburgh

Edinburgh, , United Kingdom

Site Status RECRUITING

Countries

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Canada Denmark France Germany Israel Netherlands United Kingdom

Central Contacts

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Niklas Schofer, MD

Role: CONTACT

+49-40-7410-0

Sebastian Ludwig, MD

Role: CONTACT

+49-40-7410-0

Facility Contacts

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Walid Ben Ali, MD

Role: primary

Marie-Annick Clavel, PhD

Role: primary

Jordi Dahl, MD

Role: primary

Augustin Coisne, MD

Role: primary

Marina Urena Alcazar, MD

Role: primary

Won K Kim, MD

Role: primary

Niklas Schofer, MD

Role: primary

Sebastian Ludwig, MD

Role: backup

Mohamed Abdel-Wahab, MD

Role: primary

Uri Landes, MD

Role: primary

Nicolas van Mieghem, MD

Role: primary

Mark Dweck, MD

Role: primary

References

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Cueff C, Serfaty JM, Cimadevilla C, Laissy JP, Himbert D, Tubach F, Duval X, Iung B, Enriquez-Sarano M, Vahanian A, Messika-Zeitoun D. Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart. 2011 May;97(9):721-6. doi: 10.1136/hrt.2010.198853. Epub 2010 Aug 18.

Reference Type BACKGROUND
PMID: 20720250 (View on PubMed)

Clavel MA, Messika-Zeitoun D, Pibarot P, Aggarwal SR, Malouf J, Araoz PA, Michelena HI, Cueff C, Larose E, Capoulade R, Vahanian A, Enriquez-Sarano M. The complex nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study. J Am Coll Cardiol. 2013 Dec 17;62(24):2329-38. doi: 10.1016/j.jacc.2013.08.1621. Epub 2013 Sep 24.

Reference Type BACKGROUND
PMID: 24076528 (View on PubMed)

Clavel MA, Pibarot P, Messika-Zeitoun D, Capoulade R, Malouf J, Aggarval S, Araoz PA, Michelena HI, Cueff C, Larose E, Miller JD, Vahanian A, Enriquez-Sarano M. Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol. 2014 Sep 23;64(12):1202-13. doi: 10.1016/j.jacc.2014.05.066.

Reference Type BACKGROUND
PMID: 25236511 (View on PubMed)

Ludwig S, Gossling A, Waldschmidt L, Linder M, Bhadra OD, Voigtlander L, Schafer A, Deuschl F, Schirmer J, Reichenspurner H, Blankenberg S, Schafer U, Westermann D, Seiffert M, Conradi L, Schofer N. TAVR for low-flow, low-gradient aortic stenosis: Prognostic impact of aortic valve calcification. Am Heart J. 2020 Jul;225:138-148. doi: 10.1016/j.ahj.2020.03.013. Epub 2020 Apr 8.

Reference Type BACKGROUND
PMID: 32502877 (View on PubMed)

Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Munoz D, Rosenhek R, Sjogren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL; ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017 Sep 21;38(36):2739-2791. doi: 10.1093/eurheartj/ehx391. No abstract available.

Reference Type BACKGROUND
PMID: 28886619 (View on PubMed)

Ludwig S, Schofer N, Abdel-Wahab M, Urena M, Jean G, Renker M, Hamm CW, Thiele H, Iung B, Ooms JF, Wiessman M, Mogensen NSB, Longere B, Perrin N, Ben Ali W, Coisne A, Dahl JS, Van Mieghem NM, Kornowski R, Kim WK, Clavel MA. Transcatheter Aortic Valve Replacement in Patients With Reduced Ejection Fraction and Nonsevere Aortic Stenosis. Circ Cardiovasc Interv. 2023 May;16(5):e012768. doi: 10.1161/CIRCINTERVENTIONS.122.012768. Epub 2023 May 16.

Reference Type DERIVED
PMID: 37192310 (View on PubMed)

Other Identifiers

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ATLAS TAVI

Identifier Type: -

Identifier Source: org_study_id

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