Impact of Valvulo-Arterial Impedance on Long-Term Quality of Life and Exercise Performance After Transcatheter Aortic Valve Replacement

• Published in: Circulation. Cardiovascular interventions Vol. 13; no. 1; p. e008372
• Main Authors: Nuis, Rutger-Jan, Goudzwaard, Jeannette A, de Ronde-Tillmans, Marjo J.A.G, Kroon, Herbert, Ooms, Joris F, van Wiechen, Maarten P, Geleijnse, Marcel L, Zijlstra, Felix, Daemen, Joost, Van Mieghem, Nicolas M, Mattace-Raso, Francesco U.S, Lenzen, Mattie J, de Jaegere, Peter P.T
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01.01.2020
• Subjects: transcatheter aortic valve replacement; aortic valve; arterial pressure; quality of life; echocardiography
• ISSN: 1941-7632; 1941-7640; 1941-7632
• DOI: 10.1161/CIRCINTERVENTIONS.119.008372

BACKGROUND:In aortic stenosis, valvulo-arterial impedance (Zva) estimates the overall left ventricular afterload (valve and arterial component). We investigated the association of Zva (≥5 versus <5 mm Hg mL m) on quality of life (QOL) and exercise performance (EP) ≥1 year after transcatheter aortic valve replacement (TAVR). METHODS:The study population consists of 250 TAVR patients in whom baseline Zva and follow-up QOL was prospectively assessed using EuroQOL-5-dimensions instruments; EP was assessed in 192 patients who survived ≥1 year after TAVR using questionnaires related to daily activities. In 124 patients, Zva at 1-year was also available and was used to study the change in Zva (baseline to 1 year) on QOL/EP. RESULTS:Elevated baseline Zva was present in 125 patients (50%). At a median of 28 (IQR, 17–40) months, patients with elevated baseline Zva were more limited in mobility (88% versus 71%; P=0.004), self-care (40% versus 25%; P=0.019), and independent daily activities (taking a shower53% versus 38%, P=0.030; walking 100 meter76% versus 54%, P=0.001; and walking stairs74% versus 54%, P=0.011). By multivariable analysis, elevated Zva predicted unfavorable QOL (lower EuroQOL-5-dimensions-Utility Index, odds ratio, 1.98; CI, 1.15–3.41) and unfavorable EP (any limitation in ≥3 daily activities, odds ratio, 2.55; CI, 1.41–4.62). After TAVR, the proportion of patients with elevated Zva fell from 50% to 21% and remained 21% at 1 year and was found to be associated with more limitations in mobility, self-care, and daily activities compared with patients with Zva <5 mm Hg mL m. CONCLUSIONS:Elevated Zva was seen in half of patients and predicted unfavorable long-term QOL and EP. At 1 year after TAVR, the prevalence of elevated Zva was 21% but remained associated with poor QOL/EP.