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.

中文翻译：

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经导管主动脉瓣置换后瓣膜-动脉阻抗对长期生活质量和运动表现的影响。

背景技术在主动脉瓣狭窄中，瓣膜-动脉阻抗（Zva）估计整体左心室后负荷（瓣膜和动脉成分）。我们研究了Zva（≥5vs <5 mm Hg mL-1 m-2）与经导管主动脉瓣置换（TAVR）≥1年后生活质量（QOL）和运动表现（EP）的关联。方法该研究人群包括250名TAVR患者，其中使用EuroQOL-5维度仪器对基线Zva和随访QOL进行了前瞻性评估。使用与日常活动有关的问卷调查对192例TAVR后存活≥1年的患者进行EP评估。在124位患者中，还可以使用1年时的Zva，并用于研究QOL / EP时Zva的变化（基线至1年）。结果125例患者（50％）的基线Zva升高。在中位数28（IQR，17-40）个月内，基线Zva升高的患者的活动能力受到更大限制（88％对71％； P = 0.004），自我护理（40％对25％； P = 0.019）和独立的日常活动（洗澡：53％对38百分比，P = 0.030；步行100米：76％对54％，P = 0.001；步行楼梯：74％对54％，P = 0.011。通过多变量分析，升高的Zva预测不良QOL（较低的EuroQOL-5-dimensions-Utility Index，优势比，1.98； CI，1.15-3.41）和EP不利（≥3次日常活动的任何限制，优势比，2.55； CI， 1.41-4.62）。TAVR后，Zva升高的患者比例从50％下降至21％，并在1年时仍保持21％的水平，发现与Zva <5的患者相比，其行动，自我护理和日常活动受到更多限制毫米汞柱mL-1 m-2。结论在一半的患者中Zva升高，并预测长期QOL和EP不利。TAVR后1年，Zva升高的患病率为21％，但仍与不良QOL / EP有关。