JOURNAL ARTICLE

Impact of valvuloarterial impedance on 2-year outcome of patients undergoing transcatheter aortic valve implantation

Spyridon Katsanos, Kai Hang Yiu, Marie-Annick Clavel, Josep Rodés-Cabau, Darryl Leong, Frank van der Kley, Nina Ajmone Marsan, Jeroen J Bax, Philippe Pibarot, Victoria Delgado
Journal of the American Society of Echocardiography 2013, 26 (7): 691-8
23669595

BACKGROUND: Elderly patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) often have increased calcification and fibrosis of the aorta. Indices that account for the severity of valvular obstruction and systemic vascular impedance may better assess total left ventricular afterload. The aims of the present study were to evaluate changes in valvuloarterial impedance (Zva), systemic arterial compliance, and systemic vascular resistance after TAVI and to investigate the prognostic value of these parameters.

METHODS: A total of 116 patients (49% men; mean age, 81 ± 8 years) with symptomatic severe aortic stenosis underwent TAVI. Zva, systemic arterial compliance, and systemic vascular resistance were measured at baseline and 1 and 12 months after TAVI. The primary end point was all-cause mortality.

RESULTS: After TAVI, there was a significant reduction in Zva (from 5.40 ± 1.52 mm Hg/mL/m(2) at baseline to 4.13 ± 1.17 mm Hg/mL/m(2) at 1 month and 4.35 ± 1.38 mm Hg/mL/m(2) at 1 year, P < .001). Systemic arterial compliance (from 0.57 ± 0.27 to 0.57 ± 0.28 and 0.53 ± 0.27 mL/m(2)/mm Hg, P = .408) and systemic vascular resistance (from 1,938 ± 669 to 1,856 ± 888 and 1,871 ± 767, dyne·s·cm(-5), P = .697) did not change significantly over time. During a median follow-up period of 25 months, survival rates of patients with baseline Zva ≥ 5 mm Hg/mL/m(2) were lower compared with those with Zva < 5 mm Hg/mL/m(2) (82% vs 91%, respectively, log-rank P = .04). On multivariate Cox proportional-hazards analysis, baseline Zva was independently associated with all-cause mortality (hazard ratio, 1.48; 95% confidence interval, 1.05-2.07; P = .025).

CONCLUSIONS: In patients undergoing TAVI, there is a significant postprocedural reduction in Zva, but there is no reduction in systemic arterial compliance or vascular resistance. Baseline Zva is an independent predictor of overall mortality at 2-year follow-up.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
23669595
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"