Abstract 13679: Prognostic Implication of Valvuloarterial Impedance in Patients Who Underwent Aortic Valve Replacement: Heterogeneity According to Underlying Etiology
Background: The valvuloarterial impedance (Zva) has been introduced to represent global left ventricular (LV) afterload in aortic stenosis (AS). We sought to evaluate prognostic significance of Zva after aortic valve replacement (AVR) and to test whether underlying AS etiology is associated with prognostic implication of Zva.
Methods: From 2007 to 2010, a total of 340 consecutive patients (167 men, age 65±10 years) with severe AS (indexed aortic valve area [AVA] ≤ 0.6 cm2/m2) and preserved LV ejection fraction (LVEF ≥ 50%) who underwent AVR were recruited. The Zva was calculated as: ([systolic arterial pressure + mean pressure gradient]/indexed stroke volume) mmHg/mL/m2. The primary parameter of interest was overall mortality.
Results: Tricuspid degenerative AS was present in 166 patients (Group 1, 49%), whereas bicuspid AS in 174 (Group 2, 51%). Group 1 was characterized by higher mean age (70±8 vs. 61±10 years, P < 0.001), higher prevalence of hypertension (64 vs. 45%, P < 0.001) and diabetes (28 vs. 17%, P = 0.027), and higher E/E’ ratio (19±8 vs. 16±6, P < 0.001) compared to Group 2. However, there were no differences in LVEF (63±5 vs. 64±5%, P = 0.329), indexed AVA (0.40±0.10 vs. 0.39±0.09 cm2/m2, P = 0.230), and Zva (3.7±0.8 vs. 3.8±0.8 mmHg/mL/m2, P = 0.261). During follow-up (median 1,376 days, IQR 1,016 - 1,862), there were 34 (10%) cases of overall mortality including 3 (1%) cases of operative mortality. In all patients, age (HR, 1.064; 95% CI, 1.022 - 1.107; P = 0.002), diabetes (HR, 2.150; 95% CI, 1.048 - 4.409; P = 0.037) and Zva (HR, 1.609; 95% CI, 1.099 - 2.356; P = 0.015) were independent factors associated with mortality. In survival comparison according to median Zva (3.6 mmHg/mL/m2), patients with high Zva presented significantly lower survival rate which was evident in Group 1 only, not in Group 2 (Figure).
Conclusions: Zva is associated with survival after AVR in patients with severe AS and its prognostic implication is different according underlying etiology.
Author Disclosures: B. Sun: None. S. Cheon: None. H. Park: None. M. Kim: None. H. Choi: None. P. Lee: None. J. Jang: None. D. Kim: None. J. Song: None. D. Kang: None. J. Song: None.
- © 2014 by American Heart Association, Inc.