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Association between valvuloarterial impedance after transcatheter aortic valve implantation and 2-year mortality in elderly patients with severe symptomatic aortic stenosis: the OCEAN-TAVI registry

  • Fukuko Nagura
  • Akihisa KataokaEmail author
  • Masahiko Hara
  • Ken Kozuma
  • Yusuke Watanabe
  • Makoto Nakashima
  • Hirofumi Hioki
  • Hideyuki Kawashima
  • Yugo Nara
  • Shinichi Shirai
  • Norio Tada
  • Motoharu Araki
  • Toru Naganuma
  • Futoshi Yamanaka
  • Hiroshi Ueno
  • Minoru Tabata
  • Kazuki Mizutani
  • Akihiro Higashimori
  • Kensuke Takagi
  • Masanori Yamamoto
  • Kentaro Hayashida
  • the OCEAN-TAVI investigators
Original Article
  • 27 Downloads

Abstract

Pre-procedural valvuloarterial impedance (Zva) is considered as a useful predictor of mortality in patients diagnosed as having severe aortic stenosis (AS) who undergo transcatheter aortic valve implantation (TAVI). However, the prognostic significance of post-procedural Zva remains unclear. We aimed to evaluate the prognostic significance of Zva after TAVI. We retrospectively analyzed the clinical and echocardiographic data of 1004 consecutive elderly patients (median 84 years old, 27.5% men) who underwent TAVI for severe symptomatic AS. Zva was calculated after TAVI, and patients were divided into three groups based on tertile values: the high [> 3.33 (n = 335)], intermediate [2.49–3.33 (n = 334)], and low Zva groups [< 2.49 (n = 335)]. The estimated 2-year all-cause and cardiovascular mortalities using Kaplan–Meier analysis were 16.2% [95% confidence interval (CI) 11.8–20.4] and 5.9% (95% CI 3.2–8.6), respectively. There were no significant intergroup differences in each endpoint (long-rank p = 0.518 for all-cause mortality, p = 0.757 for cardiovascular mortality). Multivariable Cox regression analyzes with adjustments of patient characteristics and medications showed that the post-procedural Zva was not associated with the 2-year all-cause mortality [intermediate Zva group versus (vs.) low Zva group: adjusted hazard ratio (aHR) = 1.34, 95% CI 0.75–2.40, p = 0.316; high Zva group vs. low Zva group: aHR = 1.17, 95% CI 0.64–2.16, p = 0.613] and cardiovascular mortality (intermediate Zva group vs. low Zva group: aHR = 1.50, 95% CI 0.56–4.06, p = 0.421; high Zva group vs. low Zva group: aHR = 1.25, 95% CI 0.43–3.65, p = 0.682). Our results suggest that post-procedural Zva was not associated with 2-year all-cause or cardiovascular mortalities in patients with severe symptomatic AS who underwent TAVI.

Keywords

Aortic stenosis Stroke Volume Index Transcatheter aortic valve implantation Valvuloarterial impedance 

Notes

Acknowledgements

The authors thank all the investigators and institutions for collecting the data, and thank the Japan Society of Clinical Research for their dedicated support for study completion.

Funding

None.

Compliance with ethical standards

Conflict of interest

Drs. Watanabe, Shirai, Tada, Araki, Naganuma, Yamamoto, and Hayashida are proctors for transfemoral-TAVI, and Dr. Tabata is a proctor of transapical TAVI for Edwards Lifesciences. Drs. Watanabe, Shirai, Naganuma, and Yamamoto are proctors of transfemoral TAVI for Medtronic. The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Fukuko Nagura
    • 1
  • Akihisa Kataoka
    • 1
    Email author
  • Masahiko Hara
    • 2
  • Ken Kozuma
    • 1
  • Yusuke Watanabe
    • 1
  • Makoto Nakashima
    • 1
  • Hirofumi Hioki
    • 1
  • Hideyuki Kawashima
    • 1
  • Yugo Nara
    • 1
  • Shinichi Shirai
    • 3
  • Norio Tada
    • 4
  • Motoharu Araki
    • 5
  • Toru Naganuma
    • 6
  • Futoshi Yamanaka
    • 7
  • Hiroshi Ueno
    • 8
  • Minoru Tabata
    • 9
  • Kazuki Mizutani
    • 10
  • Akihiro Higashimori
    • 11
  • Kensuke Takagi
    • 12
  • Masanori Yamamoto
    • 13
    • 14
  • Kentaro Hayashida
    • 15
  • the OCEAN-TAVI investigators
  1. 1.Teikyo University School of MedicineTokyoJapan
  2. 2.Shimane University Graduate School of MedicineIzumoJapan
  3. 3.Kokura Memorial HospitalKitakyushuJapan
  4. 4.Sendai Kousei HospitalSendaiJapan
  5. 5.Saiseikai Yokohama-City Eastern HospitalYokohamaJapan
  6. 6.New Tokyo HospitalChibaJapan
  7. 7.Shonankamakura General HospitalKamakuraJapan
  8. 8.Toyama University School of MedicineToyamaJapan
  9. 9.Tokyobay Urayasuichikawa Medical CenterChibaJapan
  10. 10.Osaka City University HospitalOsakaJapan
  11. 11.Kishiwada Tokushukai HospitalKishiwadaJapan
  12. 12.Ogaki Municipal HospitalGifuJapan
  13. 13.Nagoya Heart CenterNagoyaJapan
  14. 14.Toyohashi Heart CenterToyohashiJapan
  15. 15.Keio University School of MedicineTokyoJapan

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