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

• DOI: 10.1161/circinterventions.119.008372
• Publication Date: 2020-01-15T10:00:39Z
• Authors: Rutger-Jan Nuis; Jeannette A. Goud...; Marjo J.A.G. de R...; Herbert Kroon; Joris F. Ooms; Maarten P. van Wi...; Marcel L. Geleijnse; Felix Zijlstra; Joost Daemen; Nicolas M. Van Mi...; Francesco U.S. Ma...; Mattie J. Lenzen; Peter P.T. de Jae...
• Keywords: Aged, 80 and over; Male; Exercise Tolerance; Time Factors; Hemodynamics; Aortic Valve Stenosis; Recovery of Function; Severity of Illness Index; Transcatheter Aortic Valve Replacement; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Echocardiography; Risk Factors; Aortic Valve; Surveys and Questionnaires; Activities of Daily Living; Quality of Life; Humans; Female; Prospective Studies; EMC COEUR-09; Aged

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 −1 m −2 ) 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 shower: 53% versus 38%, P =0.030; walking 100 meter: 76% versus 54%, P =0.001; and walking stairs: 74% 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 −1 m −2 .

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.