Introduction
Methods
Patient population
Collected data
NT-proBNP
Echocardiography
Exercise capacity testing
Statistics
Results
Total (n = 306) | AVR (n = 141) | PVR (n = 139) | MVR (n = 21) | TVR (n = 5) | |
---|---|---|---|---|---|
Male (%) | 174 (57) | 95 (67) | 70 (50) | 8 (38) | 1 (20) |
Diagnosis (%)
| |||||
Tetralogy of Fallot | – | – | 66 | – | – |
Pulmonary atresia | – | – | 12 | – | – |
Pulmonary valve stenosis | – | – | 12 | – | – |
Bicuspid aortic valve | – | 49 | – | – | – |
(Sub)valvular aortic stenosis | – | 25 | – | – | – |
Marfan syndrome | – | 19 | – | – | – |
AVSD | – | – | – | 48 | – |
Mitral stenosis | – | – | – | 19 | – |
Ebstein malformation | – | – | – | – | 100 |
Other | – | 71
| 102
| 333
| – |
Indication for valve replacement (%)
| |||||
Regurgitation | – | 29 | 70 | 38 | 20 |
Stenosis | – | 21 | 13 | 14 | – |
Regurgitation and stenosis | – | 20 | 11 | 14 | – |
Other indications4
| – | 30 | 6 | 34 | 80 |
Age at first VR (y, SD) | 27 ± 13 | 30 ± 11 | 24 ± 13 | 25 ± 17 | 19 ± 11 |
Age at last VR (y, SD) | 30 ± 12 | 33 ± 11 | 26 ± 11 | 31 ± 13 | 29 ± 13 |
Time since last VR (y, SD) | 9 ± 7 | 11 ± 8 | 8 ± 6 | 10 ± 6 | 3 ± 4 |
Number of valve replacements (%)
| |||||
1 | 232 (76) | 105 (74) | 114 (82) | 12 (57) | 1 (20) |
2 | 59 (19) | 29 (21) | 19 (14) | 8 (38) | 3 (60) |
3 | 14 (5) | 6 (4) | 6 (4) | 1 (5) | 1 (20) |
4 | 1 (0) | 1 (1) | 0 (0) | 0 (0) | 0 (0) |
Valve type (%)
| |||||
Biological
| 133 (43) | 15 (11) | 114 (82) | 1 (5) | 3 (60) |
Bio conduit | 5 (4) | 0 (0) | 5 (4) | 0 (0) | 0 (0) |
Bio stented | 111 (83) | 7 (47) | 101 (73) | 1 (100) | 2 (67) |
Bio stentless | 11 (8) | 8 (53) | 3 (2) | 0 (0) | 0 (0) |
Transcatheter | 7 (5) | 0 (0) | 6 (4) | 0 (0) | 1 (33) |
Mechanical
| 170 (56) | 126 (89) | 22 (16) | 20 (95) | 2 (40) |
Bi-leaflet | 154 (90) | 113 (90) | 22 (100) | 17 (85) | 2 (100) |
Mono-leaflet | 16 (9) | 13 (10) | 0 (0) | 3 (15) | 0 (0) |
Valve size | 25 ± 3 | 23 ± 3 | 25 ± 2 | 29 ± 3 | 31 ± 4 |
Age (y, SD) | 39 ± 11 | 44 ± 11 | 35 ± 10 | 41 ± 13 | 32 ± 13 |
Body surface area (SD) | 1.95 ± 0.2 | 1.99 ± 0.2 | 1.92 ± 0.2 | 1.87 ± 0.2 | 1.87 ± 0.3 |
BMI (SD) | 24.7 ± 4 | 25.1 ± 4 | 24.2 ± 4 | 24.7 ± 4 | 27.5 ± 4 |
NYHA (%)
| |||||
I | 148 (48) | 82 (58) | 65 (47) | 1 (5) | 0 (0) |
II | 86 (28) | 41 (29) | 42 (30) | 3 (14) | 0 (0) |
III | 42 (14) | 10 (7) | 12 (9) | 15 (71) | 5 (100) |
IV | 4 (1) | 0 (0) | 2 (1) | 2 (10) | 0 (0) |
Unknown | 26 (9) | 8 (6) | 18 (13) | 0 (0) | 0 (0) |
NT-proBNP
Method | Variable | Total | AVR | PVR | MVR | TVR |
---|---|---|---|---|---|---|
n (%) | 306 (100) | 141 (46) | 139 (45) | 21 (7) | 5 (2) | |
Echocardiography | LVEF (%) | 55 ± 8 | 57 ± 9 | 55 ± 6 | 50 ± 11 | – |
LVEF ≥50 % (n, %) | 108 (77) | 35 (78) | 70 (78) | 3 (60) | – | |
LVEDD (mm) | 50 ± 8 | 50 ± 7 | 49 ± 8 | 53 ± 10 | 48 ± 7 | |
LVESD (mm) | 34 ± 8 | 33 ± 7 | 34 ± 7 | 41 ± 9 | 28 ± 7 | |
LV mass (g/m2 BSA) | 97 ± 33 | 98 ± 29 | 60 ± 54 | 112 ± 40 | 80 ± 28 | |
TAPSE (mm) | 17 ± 4 | 17 ± 4 | 17 ± 4 | 18 ± 3 | 15 ± 3 | |
TAPSE ≥17 mm (n, %) | 150 (56) | 59 (54) | 75 (57) | 14 (70) | 2 (40) | |
EOA (cm2/m2) | 2.1 ± 1 | 1.9 ± 1 | 2.4 ± 2 | 2.4 ± 1 | 4.9 | |
Exercise testing | VO2peak (ml/min/kg) | 27 ± 8 | 29 ± 8 | 28 ± 7 | 22 ± 7 | 19 ± 6 |
PPEC (%) | 81 ± 23 | 84 ± 24 | 76 ± 19 | 72 ± 25 | 71 ± 34 | |
PPEC ≤75 % (n, %) | 94 (41) | 32 (31) | 48 (47) | 12 (67) | 2 (50) | |
Laboratory blood | NT-proBNP | 140 ± 329 | 146 ± 374 | 108 ± 253 | 316 ± 372 | 247 ± 300 |
% High NT-proBNP | 52 | 54 | 44 | 86 | 80 |
Echocardiography and exercise testing
Associations with high NT-proBNP levels (≥125 pg/ml)
Univariate | Multivariate | |||
---|---|---|---|---|
All | All | |||
Variable | 95 % CI (B) |
p
| 95 % CI (B) |
p
|
BSA (m2) | −0.50 to 0.07 | 0.141 | – |
–
|
BMI (kg/m2) | −0.01 to 0.02 | 0.545 | – | – |
Gender | −0.41 to −0.15 |
>0.001
| −0.34 to −0.02 |
0.029
|
Age | 0.01 to 0.02 |
>0.001
| −0.01 to 0.02 | 0.310 |
NYHA class | −0.01 to 0.16 |
0.077
| −0.08 to 0.11 | 0.804 |
Age at first VR (y) | 0.00 to 0.01 | 0.164 | – | – |
Age at last VR (y) | 0.00 to 0.01 |
0.020
| −0.02 to 0.01 | 0.295*
|
Time since last VR (y) | 0.00 to 0.02 |
0.093
| – | – |
Valve size (mm) | 0.01 to 0.03 | 0.434 | – | – |
Valve type (bio/mech) | 0.00 to 0.27 |
0.055
| −0.07 to 0.25 | 0.257 |
iEOA (cm2/m2) | −0.18 to 0.12 | 0.689 | – | – |
PPM (iEOA ≤0.85 cm2/m2) | −0.21 to 0.11 | 0.520 | – | – |
Indexed LV mass (g/m2) | 0.00 to 0.00 | 0.313 | – | – |
LVEF (%) | −0.01 to 0.01 | 0.939 | – | – |
LVEDD (mm) | −0.01 to 0.01 | 0.402 | – | – |
LVESD (mm) | 0.00 to 0.02 | 0.184 | – | – |
RVEF (%) | −0.01 to 0.02 | 0.371 | – | – |
TAPSE (mm) | −0.02 to 0.02 | 0.808 | – | – |
Renal function (ml/min) | −0.01 to 0.00 |
0.022
| −0.01 to 0.00 | 0.107 |
VO2max (ml/min/kg) | −0.03 to −0.02 |
<0.001
| −0.03 to −0.01 |
<0.001
|
PPEC (%) | −0.01 to 0.00 | 0.113 | – | – |
Univariate | Multivariate | |||||||
---|---|---|---|---|---|---|---|---|
PVR | AVR | PVR | AVR | |||||
Variable | 95 % CI (B) |
P
| 95 % CI (B) |
P
| 95 % CI (B) |
P
| 95 % CI (B) |
P
|
BSA (m2) | −0.59 to 0.27 | 0.460 | −0.76 to 0.10 | 0.128 | – | – | – | – |
BMI (kg/m2) | −0.02 to 0.02 | 0.990 | −0.03 to 0.03 | 0.877 | – | – | – | – |
Gender | −0.47 to −0.08 |
0.007
| −0.52 to −0.14 |
0.001
| −0.43 to −0.01 |
0.045
| −0.57 to −0.02 |
0.034
|
Age | 0.01 to 0.03 |
0.004
| 0.00 to 0.02 |
0.047
| −0.00 to 0.05 | 0.098 | −0.01 to 0.01 | 0.951 |
NYHA class | −0.10 to 0.18 | 0.582 | −0.13 to 0.18 | 0.769 | – | – | – | – |
Age at first VR (y) | −0.00 to 0.01 | 0.119 | −0.01 to 0.01 | 0.710 | – | – | – | – |
Age at last VR (y) | −0.00 to 0.02 |
0.091
| −0.00 to 0.01 | 0.247 | −0.03 to 0.01 | 0.251 | – | – |
Time since last VR (y) | −0.01 to 0.03 | 0.174 | −0.01 to 0.02 | 0.258 | – | – | – | – |
Valve size (mm) | −0.04 to 0.05 | 0.811 | −0.06 to 0.01 | 0.172 | – | – | – | – |
Valve type (bio/mech) | −0.15 to 0.36 | 0.397 | −0.32 to 0.41 | 0.802 | – | – | – | – |
iEOA (cm2/m2) | −0.22 to 0.19 | 0.882 | −0.37 to 0.19 | 0.523 | – | – | – | – |
PPM (iEOA ≤0.85 cm2/m2) | −0.10 to 0.44 | 0.204 | −0.23 to 0.18 | 0.816 | – | – | – | – |
Indexed LV mass (g/m2) | Np | Np | −0.00 to 0.01 | 0.217 | – | – | – | – |
LVEF (%) | −0.01 to 0.02 | 0.503 | −0.03 to 0.01 | 0.440 | – | – | – | – |
LVEDD (mm) | −0.03 to 0.01 | 0.217 | −0.01 to 0.02 | 0.250 | – | – | – | – |
LVESD (mm) | −0.02 to 0.02 | 0.735 | −0.01 to 0.02 | 0.421 | – | – | – | – |
RVEF (%) | −0.01 to 0.02 | 0.666 | −0.01 to 0.02 | 0.641 | – | – | – | – |
TAPSE (mm) | −0.03 to 0.02 | 0.859 | −0.03 to 0.03 | 0.912 | – | – | – | – |
Renal function (ml/min) | −0.01 to 0.00 | 0.248 | −0.01 to −0.00 |
0.009
| – | – | −0.01 to 0.00 | 0.087 |
VO2max (ml/min/kg) | −0.04 to −0.02 |
<0.001
| −0.03 to −0.00 |
0.042
| −0.04 to −0.00 |
0.015
| −0.02 to 0.01 | 0.698 |
PPEC (%) | −0.01 to 0.00 | 0.245 | −0.01 to 0.00 | 0.922 | – | – | – | – |