Ventilatory Efficacy After Transcatheter Aortic Valve Replacement Predicts Mortality and Heart Failure Events in Elderly Patients.

Murata M; Adachi H; Nakade T; Miyaishi Y; Kan H; Okonogi S; Kuribara J;
Yamashita E; Kawaguchi R; Ezure M.

Circulation Journal. 83(10):2034-2043, 2019 09 25.
VI 1

BACKGROUND: We aimed to clarify the predictors of death or heart failure
(HF) in elderly patients who undergo transcatheter aortic valve
replacement (TAVR). Methods and Results: We prospectively enrolled 83
patients (age, 83+/-5 years) who underwent transthoracic echocardiography
(TTE) and cardiopulmonary exercise testing (CPET) with impedance
cardiography post-TAVR. We investigated the association of TTE and CPET
parameters with death and the combined outcome of death and HF
hospitalization. Over a follow-up of 19+/-9 months, peak oxygen uptake
(VO2) was not associated with death or the combined outcome. The minimum
ratio of minute ventilation (VE) to carbon dioxide production (VCO2) and
the VE vs. VCO2slope were higher in patients with the combined outcome.
After adjusting for age, sex, Society of Thoracic Surgeons score and peak
VO2, ventilatory efficacy parameters remained independent predictors of
the combined outcome (minimum VE/VO2: hazard ratio, 1.108; 95% confidence
interval, 1.010-1.215; P=0.031; VE vs. VCO2slope: hazard ratio, 1.035; 95%
confidence interval, 1.001-1.071; P=0.044), and had a greater area under
the receiver-operating characteristic curve. The VE vs. VCO2slope >=34.6
was associated with higher rates of the combined outcome, as well as lower
cardiac output at peak work rate during CPET.
CONCLUSIONS: In elderly patients, lower ventilatory efficacy post-TAVR is
a predictor of death and HF hospitalization, reflecting lower cardiac
output at peak exercise.