Aortic regurgitation following transcatheter aortic valve replacement: Impact of preprocedural left ventricular diastolic filling patterns on late clinical outcomes

Halkin, Amir; Steinvil, Arie; Aviram, Galit; Biner, Simon; Banai, Shmuel; Keren, Gad; Finkelstein, Ariel

doi:10.1002/ccd.26298

Cited by 7 publications

(12 citation statements)

References 30 publications

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“…Ten eligible studies with a total of 2380 (except for duplicate) patients with AS undergoing TAVI were identified (Table ). A study by Truong et al, which exclusively enrolled patients with AS with concomitant significant mitral annular calcification, was excluded from the present meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The HR for E/A >1.5 vs ≤1.5 from the latter study was extracted and then combined in the meta‐analysis because the latter study enrolled more patients than the former study (359 vs 146). Adjusted HRs were available in four studies and unadjusted HRs were procurable in three studies . In two studies, the unadjusted HR per average E/e' and that per ASE/EACVI‐2016 grade were statistically nonsignificant in the univariate analysis, and accordingly the average E/e' and the ASE/EACVI‐2016 grade were not entered into the multivariate analysis.…”

Section: Resultsmentioning

confidence: 99%

“…In only one study, any HRs were unavailable, thus we extracted unadjusted risk ratios instead of HRs. The calculated HR for average E/e' >8 vs ≤8 was considered as an HR for ASE/EACVI‐2016 grade II‐III vs I in a study by Conte et al, and the reported HRs for DT <160 vs ≥160 ms were regarded as HRs for ASE/EACVI‐2016 grade III versus I‐II in a study by Halkin et al…”

Section: Resultsmentioning

confidence: 99%

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Baseline left ventricular diastolic dysfunction affects midterm mortality after transcatheter aortic valve implantation

et al. 2019

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Objectives To determine whether preprocedural left ventricular (LV) diastolic dysfunction impairs midterm mortality after transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS), we performed a meta‐analysis of currently available evidence. Methods We identified all studies investigating impact of preprocedural severity of LV diastolic dysfunction on midterm (≥1‐year) all‐cause mortality after TAVI for patients with AS through a search of databases (MEDLINE and EMBASE) until September 2019. From each study, we extracted an adjusted (if unavailable, unadjusted) hazard ratio (HR) of midterm mortality. We pooled study‐specific estimates in the random‐effects model. Results Ten eligible studies with a total of 2380 patients with AS undergoing TAVI were identified. In accordance with pooled analyses, higher‐grade preprocedural LV diastolic dysfunction was associated with significantly worse midterm all‐cause mortality after TAVI compared to lower‐grade dysfunction (HR for grade II vs I, 1.15; P = .002; HR for grade III vs I, 1.35; P = .001; HR for grade III vs II; 1.16, P = .002; HR for grade II‐III vs I, II‐III vs 0‐I, or III vs I‐II, 1.34; P < .00001 [primary meta‐analysis]; HR per grade, 1.16; P = .003). No funnel plot asymmetry for the primary meta‐analysis (for grade II‐III vs I, II‐III vs 0‐I, or III vs I‐II) was identified, which probably indicated no publication bias (P = .381 by the linear‐regression test). Conclusion Higher‐grade preprocedural LV diastolic dysfunction was associated with worse midterm all‐cause mortality after TAVI for patients with AS compared to lower‐grade dysfunction.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Baseline left ventricular diastolic dysfunction affects midterm mortality after transcatheter aortic valve implantation

et al. 2019

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“…1). Following informed consent, participants were enrolled in the Tel-Aviv Prospective Angiography Study, approved by the institutional ethical committee as previously described [11]. The diagnosis of severe AS was made on the basis of clinical, echocardiographic, and hemodynamic criteria.…”

Section: Study Population and Data Collectionmentioning

confidence: 99%

“…Procedural stages have been described in detail previously [11]. Briefly, all patients underwent elective pre-procedural coronary and peripheral angiography.…”

Section: Tavr Proceduresmentioning

confidence: 99%

Diastolic mitral regurgitation following transcatheter aortic valve replacement: Incidence, predictors, and association with clinical outcomes

Flint¹,

Rozenbaum

Biner

et al. 2017

Journal of Cardiology

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Left Ventricular Diastolic Dysfunction and Transcatheter Aortic Valve Replacement Outcomes: A Review

Aalaei‐Andabili

Bavry

2019

Cardiol Ther

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Aortic stenosis (AS) is the most common valvular disease that can lead to increased afterload, left ventricular (LV) remodeling, and myocardial fibrosis. We reviewed the literature addressing the impact of transcatheter aortic valve replacement (TAVR) on LV remodeling and patients’ outcomes by elimination of AS-related high afterload. TAVR reduces afterload and improves LV remodeling recovery. However, myocardial fibrosis may not completely reverse after the TAVR. The LV diastolic dysfunction (LVDD) induced by AS is an independent predictor of post-TAVR mortality, and mortality increases with severity of LVDD. The impact of diastolic dysfunction on patient outcomes emerges at 30 days but continues to persist during mid-term follow-up. Based on severity of the baseline LVDD, some patients may tolerate post-TAVR aortic regurgitation (AR), but even minimal post-TAVR AR in patients with severe baseline LVDD can have an additive negative impact on survival. It is crucial to consider TAVR prior to development of advanced LVDD. Appropriate device selection and deployment technique are important in improvement of TAVR outcomes via elimination of AR.

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Aortic regurgitation following transcatheter aortic valve replacement: Impact of preprocedural left ventricular diastolic filling patterns on late clinical outcomes

Abstract: Preprocedural impairment of LV filling, reflected by short DT, portends an adverse prognosis in TAVR patients who develop ARpost independently of other clinical and echocardiocardigraphic measures including AS severity and systolic LV function. © 2015 Wiley Periodicals, Inc.

Cited by 7 publications

References 30 publications

Baseline left ventricular diastolic dysfunction affects midterm mortality after transcatheter aortic valve implantation

Baseline left ventricular diastolic dysfunction affects midterm mortality after transcatheter aortic valve implantation

Diastolic mitral regurgitation following transcatheter aortic valve replacement: Incidence, predictors, and association with clinical outcomes

Left Ventricular Diastolic Dysfunction and Transcatheter Aortic Valve Replacement Outcomes: A Review

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