Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Alickovic, A.
Assessment of Quality of Life and Functional Status after Percutaneous Aortic Valve Replacement
[ Diplomarbeit ] Medical University of Graz; 2011. pp. 116
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Schmidt Albrecht
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- Abstract:
- Background: Aortic stenosis (AS) is a disease with high prevalence and severe prognosis. Percutaneous aortic valve replacement (PAVR) is an alternative therapeutic option for high-risk patients with severe symptomatic AS and significant co-morbidities which may preclude them from surgical valve replacement. This study was undertaken to primarly assess the impact of PAVR on the change in Quality of Life (QoL) in our study population. Additionally, biomarkers have become increasingly important for diagnosis, risk stratification and evaluation of response to therapy in various cardiovascular diseases. We therefore sought to determine alterations in functional parameters and cardiac biomarkers in the same study group before and after PAVR. Materials and methods: From December 2009 to November 2010 30 consecutive patients with severe symptomatic aortic valve stenosis (mean age 80 ± 5 years; AVA 0.63 ± 0.21 cm2) and the indication for PAVR were enrolled. Seven different tests were employed to assess various aspects of QoL: The SF-36-Health Survey, Minnesota Living with Heart Failure Questionnaire (MLHFQ), Hospital Anxiety and Depression Scale (HADS), General Self Efficacy (GSE), ENRICHD Social Support Instrument (ESSI), Physical Activity Scale and the Maastricht Questionnaire were completed at baseline, 30 days and 6 months following PAVR. Functional improvement was assessed using echocardiography. Biomarker-analysis included routine parameters (e.g. NT-pro BNP, C-reactive protein, creatinine, haemoglobin and troponin T (TnT)), as well as novel biomarkers such as homoarginine, asymmetric and symmetric dimethylarginine (ADMA and SDMA), myeloperoxydase (MPO) and the highly sensitive troponin T (hs-TnT). Results: In all patients, PAVR resulted in an acute procedural success as indicated by a significant improvement in aortic valve area (AVA) and mean pressure gradient. This was associated with an improvement in the summarized physical health score, as assessed by the SF-36, 30 days and 6 months after PAVR, whereas the mental health summarized score remained nearly unchanged. Similarly, the physical MLHFQ subscale was characterized by a significant improvement in QoL while there was no significant change in emotional subscales of the MLHFQ. Interestingly, we did not observe any significant change in depression and anxiety according to the HADS. All patients reported positive general self efficacy and social support before the intervention and there was no further improvement after PAVR detectable by GSE and ESSI. PAVR resulted in a significant increase in easy physical activity after 30 days and in moderate physical activity after 6 months. Vital exhaustion as assessed by the Maastricht Questionnaire was robustly increased in our study population before PAVR. However, despite a tendency for improvement at the 30 days follow up, there was no significant change found when comparing the baseline and the follow up scores. With respect to biomarkers, AS was found to be associated with significantly increased levels of MPO, hs-TnT, homoarginine and NT-proBNP. Changes in MPO (and TnT) appear to closely reflect myocardial injury and inflammation before, in response to PAVR, and during recovery. Conclusion: PAVR leads to a significant improvement in various parameters of QoL, in particular physical QoL. Further studies are warranted to establish the role of MPO for risk stratification and prognosis in AS.