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Multicenter Study
. 2021 Sep 21;10(18):e019267.
doi: 10.1161/JAHA.120.019267. Epub 2021 Sep 17.

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

Hiroaki Yokoyama  1 , Futoshi Yamanaka  1   2 , Koki Shishido  1 , Tomoki Ochiai  1 , Shohei Yokota  1 , Noriaki Moriyama  1 , Yusuke Watanabe  3 , Shinichi Shirai  4 , Norio Tada  5 , Motoharu Araki  6 , Fumiaki Yashima  7 , Toru Naganuma  2   8 , Hiroshi Ueno  9 , Minoru Tabata  10 , Kazuki Mizutani  11 , Kensuke Takagi  12 , Masanori Yamamoto  13   14 , Shigeru Saito  1 , Kentaro Hayashida  15 ; OCEAN‐TAVI investigators [Link]
Collaborators, Affiliations
Multicenter Study

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

Hiroaki Yokoyama et al. J Am Heart Assoc. .

Abstract

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: <0.326; group 2: 0.326-0.453; group 3: 0.453-0.666; and group 4: >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.

Keywords: heart failure; transcatheter aortic valve replacement; ventricular‐aortic coupling.

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Conflict of interest statement

Dr Saito, Dr Yamamoto, Dr Tada, Dr Naganuma, Dr Shirai, Dr Mizutani, and Dr Watanabe are clinical proctors for Edwards Lifesciences and Medtronic. Dr Araki, Dr Tabata, Dr Takagi, and Dr Hayashida are clinical proctors of Edwards Lifesciences. Dr Ueno is a clinical proctor for Medtronic. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Schematic presentation of ventricular‐arterial coupling on the pressure‐volume relationship.
End‐systolic elastance (Ees) represents the slope of the end‐systolic pressure‐volume relationship (ESPVR), where ESP denotes end‐systolic pressure. V0 is the left ventricular (LV) volume at the point where ESPVR crosses the end‐systolic pressure of 0 mm Hg. Effective arterial elastance (Ea) represents the negative slope connecting the pressure‐volume loops between the end‐systolic point and the point on the volume axis at end‐diastole. LVEDV indicates left ventricular end‐diastolic volume; LVESP, left ventricular end‐systolic pressure; LVESV, left ventricular end‐systolic volume; PE, potential energy; SV, stroke volume; and SW, stroke work.
Figure 2
Figure 2. Midterm clinical outcomes in quartile groups according to post–transcatheter aortic valve replacement ventricular‐arterial coupling.
(A) All‐cause mortality, (B) cardiovascular (CV) death, (C) hospitalization for heart failure (HF), and (D) composite events of cardiovascular death and hospitalization for HF.
Figure 3
Figure 3. Incremental prognostic value of ventricular‐arterial coupling (VAC) over clinical indices and postprocedural left ventricular ejection fraction (LVEF).
Clinical indices: the same clinical indices in model 1 of multivariable‐adjusted analysis (Table 5).
See this image and copyright information in PMC

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