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

Abstract

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.

The relationship between baseline diastolic dysfunction and postimplantation invasive hemodynamics with transcatheter aortic valve replacement

“…Optimal management of left ventricular diastolic dysfunction among TAVR patients is not well known. 21 Diastolic dysfunction remains the same in half or more of patients 1 year after TAVR, 8,22 and myocardial fibrosis remains unchanged 9 months after surgical AVR. 23 However, patients across the spectrum of diastolic dysfunction have been shown to improve health status as early as 1 month after TAVR.…”

“…We previously reported that diastolic dysfunction Stage 3 was the strongest predictor for 1 year mortality. Optimal management of left ventricular diastolic dysfunction among TAVR patients is not well known 21 . Diastolic dysfunction remains the same in half or more of patients 1 year after TAVR, 8,22 and myocardial fibrosis remains unchanged 9 months after surgical AVR 23 .…”

The Degree of Cardiac Remodelling before Overload Relief Triggers Different Transcriptome and miRome Signatures during Reverse Remodelling (RR)—Molecular Signature Differ with the Extent of RR

“…In agreement with our results, several studies reported that cellular and ECM myocardial changes regress at different rates. In general, myocardial hypertrophy regresses much faster than fibrosis, explaining the incomplete recovery of diastolic dysfunction even when LV mass regress [ 37 , 38 ]. In our study and compared to DEB2 and SHAM group, DEB1 displays a more adverse phenotype imposing an incomplete recovery of diastolic function, as supported by several studies with AVR [ 39 , 40 ].…”

Role of advanced left ventricular imaging in adults with aortic stenosis

“…LV diastolic dysfunction is associated with increased mortality, worsens with progressive myocardial remodelling before aortic valve replacement (AVR), and gradually improves with reverse remodelling after AVR 18. The improvement of LV diastolic dysfunction in AS takes longer than the reversal of LV systolic dysfunction since the former is mainly related to long-standing LV structural changes while the latter also reflects afterload mismatch 19 20…”