Prognostic Value of Ventricular‐Arterial Coupling After Transcatheter Aortic Valve Replacement on Midterm Clinical Outcomes
Authors: Yokoyama Hiroaki , Yamanaka Futoshi , Shishido Koki , Ochiai Tomoki , Yokota Shohei , Moriyama Noriaki , Watanabe Yusuke , Shirai Shinichi , Tada Norio , Araki Motoharu , Yashima Fumiaki , Naganuma Toru , Ueno Hiroshi , Tabata Minoru , Mizutani Kazuki , Takagi Kensuke , Yamamoto Masanori , Saito Shigeru , Hayashida Kentaro , Hayashida Kentaro , Tanaka Makoto , Tsuruta Hikaru , Hase Hiromu , Yoshijima Nobuhiro , Saito Tetsuya , Myojin Sosuke , Kobari Yusuke , Ryuzaki Toshinobu , Takahashi Tatsuo , Goto Shinichi , Imaeda Shohei , Konami Yuta , Sakata Shingo , Inohara Taku , Katsumata Yoshinori , Yamamoto Masanori , Sago Mitsuru , Tsunaki Tatsuya , Adachi Yuya , Yamaguchi Ryo , Shimizu Kazuki , Koyama Yutaka , Shimura Tetsuro , Tsujimoto Satoshi , Kagase Ai , Kobayashi Toshihiro , Shibata Kenichi , Tokuda Takahiro , Sakakura Tokuya , Kawahata Ryoutaku , Nishio Hiroto , Shirai Shinichi , Hayashi Masaomi , Isotani Akihiro , Kawaguchi Tomohiro , Arai Yoshio , Taniguchi Tomohiko , Ishizu Kenichi , Fujioka Shimpei , Mori Shintaro , Morinaga Takashi , Fukunaga Masato , Tabata Hiroyuki , Kitano Kazuki , Watanabe Yusuke , Nara Yugo , Hioki Hirofumi , Kataoka Akihisa , Kawashima Hideyuki , Nagura Fukuko , Nakashima Makoto , Yamamoto Hirosada , Yukimitsu Nozomu , Sasaki Kazuya , Takamura Shintaro , Katayama Taiga , Ito Masaki , Ishibashi Ruri , Nishikawa Junichi , Iseki Yosei , Nomura Takahiro , Tsuchida Yasuyuki , Kito Kento , Fujii Misako , Harada Ayumi , Koyano Yasuki , Naganuma Toru , Mitomo Satoru , Onishi Hirokazu , Kawamoto Hiroyoshi , Yamawaki Masahiro , Honda Yohsuke , Makino Kenji , Nakano Takahide , Yamada Chinatsu , Iida Yasunori , Tada Norio , Miyasaka Masaki , Enta Yusuke , Matsumoto Takashi , Nakashima Masaki , Munehisa Yoshiko , Inoue Arata , Ishii Kazunori , Nomura Takehiro , Saigan Makoto , Hirose Suguru , Yamanaka Futoshi , Shishido Koki , Ochiai Tomoki , Mizuno Shingo , Moriyama Noriaki , Yamabe Tsuyoshi , Hattori Shigeru , Yokoyama Hiroaki , Yokota Shohei , Miyashita Hirokazu , Tabata Minoru , Obunai Kotaro , Noguchi Masahiko , Kato Nahoko , Morimura Hayato , Ito Joji , Murahsi Makio , Amano Hidewo , Kotani Shinsuke , Azumi Yuta , Ueno Hiroshi , Fukuda Nobuyuki , Sobajima Mitsuo , Onoda Hiroshi , Kuwahara Hiroyuki , Tanaka Shuhei , Ueno Yohei , Fukahara Kazuaki , Doi Toshio , Yokoyama Shigeki , Imamura Teruhiko , Ushijima Ryuichi , Oshima Akira , Hida Yuki , Mizutani Kazuki , Yashima Fumiaki , Nishida Hiroaki , Hashizume Kenichi , Ueno Koji , Ikebata Koki , Oono Masatoshi , Sudo Kiwamu , Mori Takesi , Huruse Erito , Takagi Kensuke 
Published: September 2021

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.