Prognostic Value of Ventricular‐Arterial Coupling After Transcatheter Aortic Valve Replacement on Midterm Clinical Outcomes
Hiroaki Yokoyama, Futoshi Yamanaka, Koki Shishido, Tomoki Ochiai, Shohei Yokota, Noriaki Moriyama, Yusuke Watanabe, Shinichi Shirai, Norio Tada, Motoharu Araki, Fumiaki Yashima, Toru Naganuma, Hiroshi Ueno, Minoru Tabata, Kazuki Mizutani, Kensuke Takagi, Masanori Yamamoto, Shigeru Saito, Kentaro Hayashida, Kentaro Hayashida, Makoto Tanaka, Hikaru Tsuruta, Hiromu Hase, Nobuhiro Yoshijima, Tetsuya Saito, Sosuke Myojin, Yusuke Kobari, Toshinobu Ryuzaki, Tatsuo Takahashi, Shinichi Goto, Shohei Imaeda, Yuta Konami, Shingo Sakata, Taku Inohara, Yoshinori Katsumata, Masanori Yamamoto, Mitsuru Sago, Tatsuya Tsunaki, Yuya Adachi, Ryo Yamaguchi, Kazuki Shimizu, Yutaka Koyama, Tetsuro Shimura, Satoshi Tsujimoto, Ai Kagase, Toshihiro Kobayashi, Kenichi Shibata, Takahiro Tokuda, Tokuya Sakakura, Ryoutaku Kawahata, Hiroto Nishio, Shinichi Shirai, Masaomi Hayashi, Akihiro Isotani, Tomohiro Kawaguchi, Yoshio Arai, Tomohiko Taniguchi, Kenichi Ishizu, Shimpei Fujioka, Shintaro Mori, Takashi Morinaga, Masato Fukunaga, Hiroyuki Tabata, Kazuki Kitano, Yusuke Watanabe, Yugo Nara, Hirofumi Hioki, Akihisa Kataoka, Hideyuki Kawashima, Fukuko Nagura, Makoto Nakashima, Hirosada Yamamoto, Nozomu Yukimitsu, Kazuya Sasaki, Shintaro Takamura, Taiga Katayama, Masaki Ito, Ruri Ishibashi, Jun‐ichi Nishikawa, Yosei Iseki, Takahiro Nomura, Yasuyuki Tsuchida, Kento Kito, Misako Fujii, Ayumi Harada, Yasuki Koyano, Toru Naganuma, Satoru Mitomo, Hirokazu Onishi, Hiroyoshi Kawamoto, Masahiro Yamawaki, Yohsuke Honda, Kenji Makino, Takahide Nakano, Chinatsu Yamada, Yasunori Iida, Norio Tada, Masaki Miyasaka, Yusuke Enta, Takashi Matsumoto
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.