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

TitleImpact of valvuloarterial impedance on 2-year outcome of patients undergoing transcatheter aortic valve implantation
Authors
KeywordsAged, 80 and over
Aortic Valve/physiopathology/*surgery/*ultrasonography
Aortic Valve Stenosis/mortality/physiopathology/*surgery/*ultrasonography
*Cardiac Catheterization
*Echocardiography, Doppler
Female
*Heart Valve Prosthesis
Heart Valve Prosthesis Implantation/*methods/mortality
Humans
Male
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk Factors
Severity of Illness Index
Survival Rate
Vascular Resistance
Issue Date2013
Citation
Journal of The American Society of Echocardiography, 2013, v. 26 n. 7, p. 691-698 How to Cite?
AbstractBACKGROUND: 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.
Persistent Identifierhttp://hdl.handle.net/10722/207692
ISSN
2015 Impact Factor: 4.254
2015 SCImago Journal Rankings: 2.808

 

DC FieldValueLanguage
dc.contributor.authorKatsanos, Sen_US
dc.contributor.authorYiu, KHen_US
dc.contributor.authorClavel, MAen_US
dc.contributor.authorRodes-Cabau, Jen_US
dc.contributor.authorLeong, Den_US
dc.contributor.authorvan der Kley, Fen_US
dc.contributor.authorAjmone Marsan, Nen_US
dc.contributor.authorBax, JJen_US
dc.contributor.authorPibarot, Pen_US
dc.contributor.authorDelgado, Ven_US
dc.date.accessioned2015-01-19T04:20:05Z-
dc.date.available2015-01-19T04:20:05Z-
dc.date.issued2013en_US
dc.identifier.citationJournal of The American Society of Echocardiography, 2013, v. 26 n. 7, p. 691-698en_US
dc.identifier.issn0894-7317en_US
dc.identifier.urihttp://hdl.handle.net/10722/207692-
dc.description.abstractBACKGROUND: 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.en_US
dc.languageengen_US
dc.relation.ispartofJournal of The American Society of Echocardiographyen_US
dc.subjectAged, 80 and overen_US
dc.subjectAortic Valve/physiopathology/*surgery/*ultrasonographyen_US
dc.subjectAortic Valve Stenosis/mortality/physiopathology/*surgery/*ultrasonographyen_US
dc.subject*Cardiac Catheterizationen_US
dc.subject*Echocardiography, Doppleren_US
dc.subjectFemaleen_US
dc.subject*Heart Valve Prosthesisen_US
dc.subjectHeart Valve Prosthesis Implantation/*methods/mortalityen_US
dc.subjectHumansen_US
dc.subjectMaleen_US
dc.subjectPrognosisen_US
dc.subjectProportional Hazards Modelsen_US
dc.subjectRetrospective Studiesen_US
dc.subjectRisk Factorsen_US
dc.subjectSeverity of Illness Indexen_US
dc.subjectSurvival Rateen_US
dc.subjectVascular Resistanceen_US
dc.titleImpact of valvuloarterial impedance on 2-year outcome of patients undergoing transcatheter aortic valve implantationen_US
dc.typeArticleen_US
dc.identifier.emailYiu, KH: khkyiu@hku.hken_US
dc.identifier.authorityYiu, KH=rp01490en_US
dc.identifier.doi10.1016/j.echo.2013.04.003en_US
dc.identifier.hkuros254857-
dc.identifier.volume26en_US
dc.identifier.issue7en_US
dc.identifier.spage691en_US
dc.identifier.epage698en_US

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