Central blood pressure profile variability and prognostic impact of transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) is a proven treatment for severe aortic stenosis (AS); however, the effects of TAVI on central blood pressure (CBP) and clinical outcomes remain unclear. We assessed CBP indices before and after TAVI and their prognostic value. Seventy-six patients with severe AS who underwent TAVI were retrospectively evaluated, and CBP was estimated noninvasively 1 day before and after TAVI. The following indices were measured: augmentation index corrected for heart rate (HR) (AIx@HR75), peak pressure of the forward wave (Pf) and backward wave (Pb), time to peak pressure of the forward wave corrected for HR (Tfc) and the backward wave corrected for HR (Tbc), and ejection duration (ED). The primary endpoint was the composite outcome of all-cause mortality and hospitalized heart failure. The median follow-up period was 1135 (844–1404) days. Tfc, Tbc, ED, Pb, and AIx@HR75 decreased despite no significant changes in Pf after TAVI. The univariable Cox proportional hazards model showed that ED 1 day after TAVI was associated with composite outcomes (hazard ratio: 1.02; 95% confidence interval [CI]: 1.01–1.04; P = 0.002). When the patients were divided into two groups by the cutoff value determining composite outcomes by receiver operating characteristic curve analysis, a long ED 1 day after TAVI was significantly associated with composite outcomes by Kaplan–Meier curve analysis (log-rank test, P < 0.001). The multivariable Cox proportional hazards model showed that a long ED 1 day after TAVI was associated with composite outcomes (adjusted hazard ratio: 12.12; 95% CI 2.41–60.81; P = 0.002). In conclusion, a long ED 1 day after TAVI was associated with adverse clinical outcomes.