Valvuloarterial Impedance Predicts Heart Failure Readmissions in Patients Undergoing Transcatheter Aortic Valve Replacement

BackgroundElevated valvuloarterial impedance (Zva) has been associated with mortality in severe aortic stenosis (AS) patients. However, its role in predicting heart failure (HF) readmissions after transcatheter aortic valve replacement (TAVR) remains unknown.MethodsWe evaluated 198 consecutive patients who underwent TAVR at our institution from 2012 to 2016. Clinical, laboratory, procedural, echocardiographic (ECHO) data and HF readmissions at 1-year were collected. Zva was calculated from ECHO as (systolic blood pressure + transvalvular gradient)/stroke volume index.ResultsThe mean age of all patients was 82 ± 7 years, 51% were males and 95% were Caucasians. Median duration of follow-up was 9 (Interquartile range: 12) months. The majority of patients had hypertension (93%) and 24.7% had heart failure symptoms with reduced EF (<50%). Use of beta-blockers was 64%, diuretics was 64%, angiotensin converting enzyme inhibitors was 25%, aldosterone receptor blockers was 16%, and potassium-sparing diuretics was 8%. Patients with a high pre-TAVR Zva (≥6.3 mmHg.mL−1.m2) were more likely to present with HF readmissions at 1-year in both unadjusted (34.2% vs. 18.1%, p = 0.03) and adjusted analysis (Hazards Ratio HR = 2.08 95%CI: 1.00–4.29, p = 0.04). Patients with a Zva that either remained unchanged or increased post-TAVR had significantly higher mortality at 1-year post-procedure in the unadjusted (18.2% vs. 6.3%, p = 0.02) and adjusted analysis (HR = 2.97 95%CI: 1.07–8.25, p = 0.04).ConclusionZva is a novel prognostic marker for HF readmissions at 1-year post-TAVR and can be routinely measured on ECHO. Further prospective studies validating the utility of Zva for risk stratification are warranted.