TY - JOUR
T1 - Dynamic changes in aortic impedance after transcatheter aortic valve replacement and its impact on exploratory outcome
AU - Kobayashi, Yukari
AU - Kim, Juyong B.
AU - Moneghetti, Kegan J.
AU - Kobayashi, Yuhei
AU - Zhang, Ran
AU - Brenner, Daniel A.
AU - O’Malley, Ryan
AU - Schnittger, Ingela
AU - Fischbein, Michael
AU - Miller, D. Craig
AU - Yeung, Alan C.
AU - Liang, David
AU - Haddad, Francois
AU - Fearon, William F.
N1 - Publisher Copyright:
© 2017, Springer Science+Business Media Dordrecht.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Valvulo-arterial impedance (Zva) has been shown to predict worse outcome in medically managed aortic stenosis (AS) patients. We aimed to investigate the association between Zva and left ventricular (LV) adaptation and to explore the predictive value of Zva for cardiac functional recovery and outcome after transcatheter aortic valve replacement (TAVR). We prospectively enrolled 128 patients with AS who underwent TAVR. Zva was calculated as: (systolic blood pressure + mean transaortic gradient)/stroke volume index). Echocardiographic assessment occurred at baseline, 1-month and 1-year after TAVR. The primary endpoints were to investigate associations between Zva and global longitudinal strain (GLS) at baseline as well as GLS change after TAVR. The secondary was to compare all-cause mortality after TAVR between patients with pre-defined Zva (=5 mmHg m2/ml), stroke volume index (=35 ml/m2), and GLS (=−15%) cutoffs. The mean GLS was reduced (−13.0 ± 3.2%). The mean Zva was 5.2 ± 1.6 mmHg*m2/ml with 55% of values ≥5.0 mmHg*m2/ml, considered to be abnormally high. Higher Zva correlated with worse GLS (r = −0.33, p < 0.001). After TAVR, Zva decreased significantly (5.1 ± 1.6 vs. 4.5 ± 1.6 mmHg*m2/ml, p = 0.001). A reduction of Zva at 1-month was associated with GLS improvement at 1-month (r = −0.31, p = 0.001) and at 1-year (r = −0.36 and p = 0.001). By Kaplan–Meier analysis, patients with higher Zva at baseline had higher mortality (Log-rank p = 0.046), while stroke volume index and GLS did not differentiate outcome (Log-rank p = 0.09 and 0.25, respectively). As a conclusion, Zva is correlated with GLS in AS as well as GLS improvement after TAVR. Furthermore, a high baseline Zva may have an additional impact to traditional parameters on predicting worse mortality after TAVR.
AB - Valvulo-arterial impedance (Zva) has been shown to predict worse outcome in medically managed aortic stenosis (AS) patients. We aimed to investigate the association between Zva and left ventricular (LV) adaptation and to explore the predictive value of Zva for cardiac functional recovery and outcome after transcatheter aortic valve replacement (TAVR). We prospectively enrolled 128 patients with AS who underwent TAVR. Zva was calculated as: (systolic blood pressure + mean transaortic gradient)/stroke volume index). Echocardiographic assessment occurred at baseline, 1-month and 1-year after TAVR. The primary endpoints were to investigate associations between Zva and global longitudinal strain (GLS) at baseline as well as GLS change after TAVR. The secondary was to compare all-cause mortality after TAVR between patients with pre-defined Zva (=5 mmHg m2/ml), stroke volume index (=35 ml/m2), and GLS (=−15%) cutoffs. The mean GLS was reduced (−13.0 ± 3.2%). The mean Zva was 5.2 ± 1.6 mmHg*m2/ml with 55% of values ≥5.0 mmHg*m2/ml, considered to be abnormally high. Higher Zva correlated with worse GLS (r = −0.33, p < 0.001). After TAVR, Zva decreased significantly (5.1 ± 1.6 vs. 4.5 ± 1.6 mmHg*m2/ml, p = 0.001). A reduction of Zva at 1-month was associated with GLS improvement at 1-month (r = −0.31, p = 0.001) and at 1-year (r = −0.36 and p = 0.001). By Kaplan–Meier analysis, patients with higher Zva at baseline had higher mortality (Log-rank p = 0.046), while stroke volume index and GLS did not differentiate outcome (Log-rank p = 0.09 and 0.25, respectively). As a conclusion, Zva is correlated with GLS in AS as well as GLS improvement after TAVR. Furthermore, a high baseline Zva may have an additional impact to traditional parameters on predicting worse mortality after TAVR.
KW - Strain imaging
KW - Transcatheter aortic valve replacement
KW - Ventricular impedance
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U2 - 10.1007/s10554-017-1155-6
DO - 10.1007/s10554-017-1155-6
M3 - Article
C2 - 28516313
AN - SCOPUS:85019639439
SN - 1569-5794
VL - 33
SP - 1693
EP - 1701
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
IS - 11
ER -