Impact of left ventricular diastolic function and survival in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

Abstract

In year 2016, the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) updated Recommendations for the assessment and grading of diastolic dysfunction (DD). We aimed to assess the applicability of this DD grading method and its association with prognosis in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI). We retrospectively identified 237 consecutive patients with severe AS who underwent trans-femoral TAVI. Baseline transthoracic echocardiography was evaluated to assess pre- and post-TAVI diastolic function according to the current ASE/EACVI Recommendations. Prior to TAVI, 41 (17%) patients were diagnosed as having grade I DD, 111 (47%) patients had grade II DD, 80 (34%) had grade III DD. DD grade after TAVI decreased (p < 0.001) with 75 patients (32%) reclassified to a lower DD grade. During the median follow-up of 1,320 days, 136 (57%) patients died. In univariable Cox proportional hazards model analysis, neither pre- nor post-TAVI DD grade were associated with prognosis. However, patients with grade III DD detected before TAVI and AR≥ 2 after TAVI had poorer survival (p<0.008). Patients with grade III DD detected after TAVI and AR≥ 2 after TAVI had poorer prognosis (p = 0.002). TAVI improves DD grade. While poor DD grade was not associated with mortality after treatment of AS by TAVI, concomitant presence of DD and post-procedural AR carried a poor prognosis.

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

“…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.…”

“…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. In only one study, any HRs were unavailable, thus we extracted unadjusted risk ratios instead of HRs.…”

“…Ten eligible studies [12][13][14][15][16][17][18][19][20][21] 14 average E/e' in one study, 15 deceleration time of early filling velocity (DT) in one study, 16 and E/A in one study. 19 Extracted and calculated HRs of midterm allcause mortality were listed in Table 2 and an HR for E/A >1.5 vs ≤1.5 (corresponding to ASE/ESC-2009 grade III vs I-II dysfunction) was procurable in the latter study.…”

“…The grade of preprocedural LV diastolic dysfunction may be improved after TAVI. Sato et al showed that the grade was ameliorated to I in 36.2% of preprocedural grade‐II patients and to I‐II in 51.9% of preprocedural grade‐III patients within 7 days after TAVI. At 1 year after TAVI in a study by Asami et al, the grade was improved to 0‐I in 30.2% of preprocedural grade‐II patients and to 0‐II in 52.2% of preprocedural grade‐III patients.…”

“…Furthermore, preprocedural grade‐III diastolic dysfunction and postprocedural ≥mild AR was independently associated with worse 2‐year survival (HR, 7.17; 95%CI, 1.28‐40.17; P = .025) . Sato et al showed that preprocedural grade III ( P = .008), as well as postprocedural (within 30 days) grade III ( P = .002), with postprocedural ≥mild AR was independently associated with greater 6‐year mortality.…”