Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Sep 2021)

Prognostic Value of Ventricular‐Arterial Coupling After Transcatheter Aortic Valve Replacement on Midterm Clinical Outcomes

  • Hiroaki Yokoyama,
  • Futoshi Yamanaka,
  • Koki Shishido,
  • Tomoki Ochiai,
  • Shohei Yokota,
  • Noriaki Moriyama,
  • Yusuke Watanabe,
  • Shinichi Shirai,
  • Norio Tada,
  • Motoharu Araki,
  • Fumiaki Yashima,
  • Toru Naganuma,
  • Hiroshi Ueno,
  • Minoru Tabata,
  • Kazuki Mizutani,
  • Kensuke Takagi,
  • Masanori Yamamoto,
  • Shigeru Saito,
  • Kentaro Hayashida

DOI
https://doi.org/10.1161/JAHA.120.019267
Journal volume & issue
Vol. 10, no. 18

Abstract

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Background Ventricular‐arterial coupling predicts outcomes in patients with heart failure. The arterial elastance to end‐systolic elastance ratio (Ea/Ees) is a noninvasively assessed index that reflects ventricular‐arterial coupling. We aimed to determine the prognostic value of ventricular‐arterial coupling assessed through Ea/Ees after transcatheter aortic valve replacement to predict clinical events. Methods and Results We retrieved data on 1378 patients (70% women) who underwent transcatheter aortic valve replacement between October 2013 and May 2017 from the OCEAN‐TAVI (Optimized transCathEter vAlvular iNtervention) Japanese multicenter registry. We determined the association between Ea/Ees and the composite end point of hospitalization for heart failure and cardiovascular death by classifying the patients into quartiles based on Ea/Ees values (group 1: 0.666) during the midterm follow‐up after transcatheter aortic valve replacement. During a median follow‐up period of 736 days (interquartile range, 414–956), there were 247 (17.9%) all‐cause deaths, 89 (6.5%) cardiovascular deaths, 130 (9.4%) hospitalizations for heart failure, and 199 (14.4%) composite events of hospitalization for heart failure and cardiovascular death. The incidence of the composite end point was significantly higher in group 2 (hazard ratio [HR], 1.76; 95% CI, 1.08–2.87 [P=0.024]), group 3 (HR, 2.43; 95% CI, 1.53–3.86 [P<0.001]), and group 4 (HR, 2.89; 95% CI, 1.83–4.57 [P<0.001]) than that in group 1. On adjusted multivariable Cox analysis, Ea/Ees was significantly associated with composite events (HR, 1.47 per 1‐unit increase; 95% CI, 1.08–2.01 [P=0.015]). Conclusions These findings suggest that a higher Ea/Ees at discharge after transcatheter aortic valve replacement is associated with adverse clinical outcomes during midterm follow‐up. Registration URL: https://www.upload.umin.ac.jp/. Unique identifier: UMIN000020423.

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