Abstract
Background: Respiratory instability, which can be quantified using respiratory stability time (RST), is associated with the severity and prognostic impact of the disease in patients with chronic heart failure. However, its clinical implications in patients with severe aortic stenosis receiving transcatheter aortic valve replacement (TAVR) remain unknown. Methods: Patients who received TAVR and had paired measurements of RST at a baseline and one week following TAVR were prospectively included. Changes in RST following TAVR and its impact on post-TAVR heart failure readmissions were investigated. Results: Seventy-one patients (median age, 86 years old; 35% men) were included. The baseline RST was correlated with the severity of heart failure including elevated levels of plasma B-type natriuretic peptide (p < 0.05 for all). RST improved significantly following TAVR from 34 (26, 37) s to 36 (33, 38) s (p < 0.001). Post-TAVR lower RST (<33 s, n = 18) was associated with a higher 2-year cumulative incidence of heart failure readmission (21% vs. 8%, p = 0.039) with a hazard ratio of 5.47 (95% confidence interval 0.90–33.2). Conclusion: Overall, respiratory instability improved following TAVR. Persistent respiratory instability following TAVR was associated with heart failure recurrence.
Highlights
Aortic stenosis (AS) is a dominant cause of valvular heart diseases
Asanoi and colleagues recently introduced a novel methodology to quantify the severity of respiratory instability by measuring respiratory stability time (RST), which reflects the magnitude of the non-periodic irregular respiratory fluctuations as well as Cheyne–Stokes respiration [8]
We investigated the change in RST following transcatheter aortic valve replacement (TAVR) and the prognostic impact of post-TAVR RST
Summary
Aortic stenosis (AS) is a dominant cause of valvular heart diseases. Transcatheter aortic valve replacement (TAVR) is an established treatment of severe AS in a high surgical risk cohort [1] or even in a low surgical risk cohort [2,3]. The sympathetic nervous system is inappropriately activated during the progression of worsening heart failure [4]. Respiratory stability is largely affected by the inappropriate activation of the sympathetic nervous system via the association between the respiratory system, the autonomic centers, and hemodynamics [5–7]. Respiratory instability is an established surrogate of heart failure severity. Asanoi and colleagues recently introduced a novel methodology to quantify the severity of respiratory instability by measuring respiratory stability time (RST), which reflects the magnitude of the non-periodic irregular respiratory fluctuations as well as Cheyne–Stokes respiration [8]. All-night RST is a quantitative measure of respiration that reflects the clinical status of congestive signs and the recovery process from heart failure decompensation [9]. Respiratory instability may improve following TAVR due to hemodynamic amelioration [10]. We investigated peri-TAVR changes in RST as a primary concern and its prognostic impact as a secondary concern
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