TY  - BOOK
AU  - Weissman, Neil J
TI  - Blood Pressure and Arterial Load After Transcatheter Aortic Valve Replacement for Aortic Stenosis
SN  - 1941-9651
PY  - 2017///
KW  - *Aortic Valve Stenosis/su [Surgery]
KW  - *Aortic Valve/su [Surgery]
KW  - *Arterial Pressure
KW  - *Pulsatile Flow
KW  - *Transcatheter Aortic Valve Replacement
KW  - *Vascular Resistance
KW  - Aged
KW  - Aged, 80 and over
KW  - Aortic Valve Stenosis/dg [Diagnostic Imaging]
KW  - Aortic Valve Stenosis/mo [Mortality]
KW  - Aortic Valve Stenosis/pp [Physiopathology]
KW  - Aortic Valve/dg [Diagnostic Imaging]
KW  - Aortic Valve/pp [Physiopathology]
KW  - Clinical Trials as Topic
KW  - Echocardiography, Doppler
KW  - Female
KW  - Humans
KW  - Kaplan-Meier Estimate
KW  - Male
KW  - North America
KW  - Proportional Hazards Models
KW  - Registries
KW  - Retrospective Studies
KW  - Risk Factors
KW  - Severity of Illness Index
KW  - Time Factors
KW  - Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
KW  - Transcatheter Aortic Valve Replacement/mo [Mortality]
KW  - Treatment Outcome
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N2  - BACKGROUND: After aortic valve replacement, left ventricular afterload is often characterized by the residual valve obstruction. Our objective was to determine whether higher systemic arterial afterload-as reflected in blood pressure, pulsatile and resistive load-is associated with adverse clinical outcomes after transcatheter aortic valve replacement (TAVR); CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894. Copyright � 2017 American Heart Association, Inc; CONCLUSIONS: Even after relief of valve obstruction in patients with aortic stenosis, there is an independent association between post-TAVR blood pressure, systemic arterial load, and mortality. Blood pressure goals in patients with a history of aortic stenosis may need to be redefined. Increased pulsatile arterial load, rather than blood pressure, may be a target for adjunctive medical therapy to improve outcomes after TAVR; METHODS AND RESULTS: Total, pulsatile, and resistive arterial load were measured in 2141 patients with severe aortic stenosis treated with TAVR in the PARTNER I trial (Placement of Aortic Transcatheter Valve) who had systolic blood pressure (SBP) and an echocardiogram obtained 30 days after TAVR. The primary end point was 30-day to 1-year all-cause mortality. Lower SBP at 30 days after TAVR was associated with higher mortality (20.0% for SBP 100-129 mmHg versus 12.0% for SBP 130-170 mmHg; P<0.001). This association remained significant after adjustment, was consistent across subgroups, and confirmed in sensitivity analyses. In adjusted models that included SBP, higher total and pulsatile arterial load were associated with increased mortality (P<0.001 for all), but resistive load was not. Patients with low 30-day SBP and high pulsatile load had a 3-fold higher mortality than those with high 30-day SBP and low pulsatile load (26.1% versus 8.1%; hazard ratio, 3.62; 95% confidence interval, 2.36-5.55)
UR  - https://dx.doi.org/10.1161/CIRCIMAGING.116.006308
ER  -