TY - JOUR
T1 - Immediate reduction in left ventricular ejection time following TAVI is associated with improved quality of life
AU - Schenk, Jimmy
AU - Kho, Eline
AU - Rellum, Santino
AU - Kromhout, Joris
AU - Vlaar, Alexander P. J.
AU - Baan, Jan
AU - van Mourik, Martijn S.
AU - Jorstad, Harald T.
AU - van der Ster, Björn J. P.
AU - Westerhof, Berend E.
AU - Bruns, Steffen
AU - Immink, Rogier V.
AU - Vis, Marije M.
AU - Veelo, Denise P.
N1 - Publisher Copyright: Copyright © 2022 Schenk, Kho, Rellum, Kromhout, Vlaar, Baan, van Mourik, Jorstad, van der Ster, Westerhof, Bruns, Immink, Vis and Veelo.
PY - 2022/9/16
Y1 - 2022/9/16
N2 - Background: TAVI has shown to result in immediate and sustained hemodynamic alterations and improvement in health-related quality of life (HRQoL), but previous studies have been suboptimal to predict who might benefit from TAVI. The relationship between immediate hemodynamic changes and outcome has not been studied before. This study sought to assess whether an immediate hemodynamic change, reflecting myocardial contractile reserve, following TAVI is associated with improved HRQoL. Furthermore, it assessed whether pre-procedural cardiac power index (CPI) and left ventricular ejection fraction (LVEF) could predict these changes. Methods: During the TAVI procedure, blood pressure and systemic hemodynamics were prospectively collected with a Nexfin® non-invasive monitor. HRQoL was evaluated pre-procedurally and 12 weeks after the procedure, using the EQ-5D-5L classification tool. Results: Overall, 97/114 (85%) of the included patients were eligible for analyses. Systolic, diastolic and mean arterial pressure, heart rate, and stroke volume increased immediately after TAVI (all p < 0.005), and left ventricular ejection time (LVET) immediately decreased with 10 ms (95%CI = −4 to −16, p < 0.001). Overall HRQoLindex increased from 0.810 [0.662–0.914] before to 0.887 [0.718–0.953] after TAVI (p = 0.016). An immediate decrease in LVET was associated with an increase in HRQoLindex (0.02 index points per 10 ms LVET decrease, p = 0.041). Pre-procedural CPI and LVEF did not predict hemodynamic changes or change in HRQoL. Conclusion: TAVI resulted in an immediate hemodynamic response and increase in HRQoL. Immediate reduction in LVET, suggesting unloading of the ventricle, was associated with an increase in HRQoL, but neither pre-procedural CPI nor LVEF predicted these changes. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT03088787
AB - Background: TAVI has shown to result in immediate and sustained hemodynamic alterations and improvement in health-related quality of life (HRQoL), but previous studies have been suboptimal to predict who might benefit from TAVI. The relationship between immediate hemodynamic changes and outcome has not been studied before. This study sought to assess whether an immediate hemodynamic change, reflecting myocardial contractile reserve, following TAVI is associated with improved HRQoL. Furthermore, it assessed whether pre-procedural cardiac power index (CPI) and left ventricular ejection fraction (LVEF) could predict these changes. Methods: During the TAVI procedure, blood pressure and systemic hemodynamics were prospectively collected with a Nexfin® non-invasive monitor. HRQoL was evaluated pre-procedurally and 12 weeks after the procedure, using the EQ-5D-5L classification tool. Results: Overall, 97/114 (85%) of the included patients were eligible for analyses. Systolic, diastolic and mean arterial pressure, heart rate, and stroke volume increased immediately after TAVI (all p < 0.005), and left ventricular ejection time (LVET) immediately decreased with 10 ms (95%CI = −4 to −16, p < 0.001). Overall HRQoLindex increased from 0.810 [0.662–0.914] before to 0.887 [0.718–0.953] after TAVI (p = 0.016). An immediate decrease in LVET was associated with an increase in HRQoLindex (0.02 index points per 10 ms LVET decrease, p = 0.041). Pre-procedural CPI and LVEF did not predict hemodynamic changes or change in HRQoL. Conclusion: TAVI resulted in an immediate hemodynamic response and increase in HRQoL. Immediate reduction in LVET, suggesting unloading of the ventricle, was associated with an increase in HRQoL, but neither pre-procedural CPI nor LVEF predicted these changes. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT03088787
KW - TAVI
KW - cardiac power index
KW - ejection fraction
KW - hemodynamics
KW - quality of life
UR - http://www.scopus.com/inward/record.url?scp=85139142553&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fcvm.2022.988840
DO - https://doi.org/10.3389/fcvm.2022.988840
M3 - Article
C2 - 36187009
SN - 2297-055X
VL - 9
JO - Frontiers in cardiovascular medicine
JF - Frontiers in cardiovascular medicine
M1 - 988840
ER -