Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands.
Section of Geriatrics, Department of Internal Medicine (J.A.G., F.U.S.M.-R.), Erasmus MC, Rotterdam, the Netherlands.
Circ Cardiovasc Interv. 2020 Jan;13(1):e008372. doi: 10.1161/CIRCINTERVENTIONS.119.008372. Epub 2020 Jan 15.
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 m) on quality of life (QOL) and exercise performance (EP) ≥1 year after transcatheter aortic valve replacement (TAVR).
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.
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%; =0.004), self-care (40% versus 25%; =0.019), and independent daily activities (taking a shower: 53% versus 38%, =0.030; walking 100 meter: 76% versus 54%, =0.001; and walking stairs: 74% versus 54%, =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 m.
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.
在主动脉瓣狭窄中，脉管阻抗（Zva）评估左心室整体后负荷（瓣膜和动脉成分）。我们研究了经导管主动脉瓣置换术（TAVR）后 1 年时 Zva（≥5 与<5mmHg·mL·m）与生活质量（QOL）和运动表现（EP）的关系。
研究人群包括 250 例接受 TAVR 的患者，前瞻性使用欧洲五维健康量表评估基线 Zva 和随访 QOL；192 例存活超过 1 年的患者使用与日常活动相关的问卷评估 EP。在 124 例患者中，还获得了 1 年时的 Zva，并用于研究 Zva（基线至 1 年）变化对 QOL/EP 的影响。
中位时间 28（IQR，17-40）个月时，基线 Zva 升高的患者在移动性（88%比 71%；=0.004）、自我护理（40%比 25%；=0.019）和独立日常活动（洗澡：53%比 38%，=0.030；步行 100 米：76%比 54%，=0.001；和爬楼梯：74%比 54%，=0.011）方面受限更多。多变量分析显示，升高的 Zva 预测 QOL 不良（欧洲五维健康量表-效用指数较低，优势比 1.98；95%CI，1.15-3.41）和 EP 不良（≥3 项日常活动受限，优势比 2.55；95%CI，1.41-4.62）。TAVR 后，Zva 升高患者的比例从 50%降至 21%，1 年后仍为 21%，与 Zva<5mmHg·mL·m 的患者相比，移动性、自我护理和日常活动受限更为严重。
一半患者存在 Zva 升高，且预测长期 QOL 和 EP 不良。TAVR 后 1 年，Zva 升高的患病率为 21%，但仍与 QOL/EP 不良相关。
