Impact of Prosthesis-Patient Mismatch on Hemodynamics During Exercise in Patients With Aortic Stenosis After Transcatheter Aortic Valve Implantation With a Balloon-Expandable Valve

Figures

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  Figure 1. Flow diagram of patient recruitment. TAVI, transcatheter aortic valve implantation; ESE, exercise stress echocardiography; PPM, prosthesis-patient mismatch.

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  Figure 2. The relationship between the mean PG and EOAi at rest and during exercise. Inverse simple regression analysis of the mean PG and EOAi at rest (r = 0.421; p < 0.001) and during exercise (r = 0.440; p < 0.001). Mean PG, mean transvalvular pressure gradient; EOAi, effective orifice area index.

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  Figure 3. The changes in the mean PG, Zva and SPAP from rest to exercise. (A) mean PG increase from rest to exercise; (B) Zva increase from rest to exercise; (C) SPAP increase from rest to exercise. The increase in the mean PG and Zva from rest to exercise was greater in patients with PPM than in those without PPM. Patients with PPM had a higher SPAP increase than patients without PPM (57.3 ± 13.8 mmHg vs. 49.7 ± 10.9 mmHg). PPM = prosthesis-patient mismatch; Mean PG, mean transvalvular pressure gradient; Zva, valvulo-arterial impedance; SPAP, systolic pulmonary artery pressure. P-value, PPM vs. non-PPM.

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  Figure 4. The relationship between the SPAP and CO at rest and during exercise. The CO tended to be lower and the SPAP was higher in patients with PPM than in those without PPM both at rest and during exercise. The slopes showed that ΔSPAP/ΔCO was higher in patients with PPM than in those without PPM, but the difference was not statistically significant (23.9 ± 45.9 vs. 8.9 ± 14.4, p = 0.202).SPAP = systolic pulmonary artery pressure; CO, cardiac output; PPM, prosthesis-patient mismatch; ΔSPAP/ΔCO, the ratio of the change in SPAP and the change in CO.

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  Figure 5. The Kaplan-Meier survival curves for all-cause mortality and heart failure-related hospitalization. (A) Primary endpoint (composite outcomes including all-cause mortality, cardiovascular mortality, cardiovascular event, and heart failure-related hospitalization); (B) Secondary endpoint (heart failure-related hospitalization). There were no differences in the primary and secondary endpoints between the PPM and non-PPM groups. PPM, prosthesis-patient mismatch.