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Impact of Valvulo-Arterial Impedance on Long-Term Quality of Life and Exercise Performance After Transcatheter Aortic Valve Replacement.
Circulation: Cardiovascular Interventions ( IF 6.1 ) Pub Date : 2020-01-15 , DOI: 10.1161/circinterventions.119.008372
Rutger-Jan Nuis 1 , Jeannette A Goudzwaard 2 , Marjo J A G de Ronde-Tillmans 1 , Herbert Kroon 1 , Joris F Ooms 1 , Maarten P van Wiechen 1 , Marcel L Geleijnse 1 , Felix Zijlstra 1 , Joost Daemen 1 , Nicolas M Van Mieghem 1 , Francesco U S Mattace-Raso 2 , Mattie J Lenzen 1 , Peter P T de Jaegere 1
Affiliation  

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:

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。
更新日期:2020-01-15
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