Author + information
- Cheng-Han Chen,
- Matthew Brinkman,
- Omar Khalique,
- Tamim Nazif,
- Torsten Vahl,
- Isaac George,
- Amisha Patel,
- Pablo Codner,
- Remi Kouz,
- Juan Terre,
- Jennifer Jantz,
- Ming Liao,
- Martin Leon,
- Susheel Kodali and
- Rebecca Hahn
Background: Valvuloarterial impedence (Zva) is a measure of left ventricular hemodynamic load in patients with severe aortic stenosis (AS) and been associated with increased mortality. We evaluated the impact of Zva on prognosis in patients undergoing transcatheter aortic valve replacement (TAVR).
Methods: We analyzed 840 patients with severe AS who underwent TAVR. Baseline Zva was calculated as the sum of the systolic blood pressure and mean transaortic gradient, divided by the stroke volume index. Systemic arterial compliance (SAC) was calculated as the stroke volume index divided by the pulse pressure. The primary end point for this study was overall mortality at 1 year.
Results: Using receiver operating characteristic curve analysis, a Zva of ≥ 5.3 mmHg/mL/m2 was determined to be the best cutoff value to be associated with the primary end point. On univariate Cox regression analysis, Zva ≥ 5.3 mmHg/mL/m2 (HR 1.7; 95% CI [1.14-2.25], p = 0.007), mean gradient < 40 mmHg (HR 1.8, CI [1.31-2.53], p=0.0003) and SVI < 35 ml/m2 (HR 1.6, CI [1.14-2.21], p=0.006) were identified as predictors of 1-year mortality after TAVR. Although SAC was not predictive of outcomes, SBP ≥ 130 mmHg (HR 0.70, 95% CI [0.51-0.97], p=0.03) and DBP ≥ 65 mmHg (HR 0.73, 95% CI [0.62-1.06], p=0.054) appeared to be protective.
Conclusions: In the largest study to date utilizing Zva as a measure of left ventricular load in patients with severe AS, Zva ≥ 5.3 was found to predict increased all-cause 1-year mortality after TAVR.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 1:15 p.m.-1:25 p.m.
Session Title: TAVR Outcomes Prognostication
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1221M-09
- 2017 American College of Cardiology Foundation