Preoperative Moderate to Severe Diastolic Dysfunction: A Novel Doppler Echocardiographic Long-term Prognostic Factor in Patients With Severe Aortic Stenosis

Gjertsson, Peter; Caidahl, Kenneth; Farasati, M.; Odén, Anders; Bech‐Hanssen, Odd

doi:10.1016/j.accreview.2005.08.043

Cited by 30 publications

(40 citation statements)

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“…Furthermore, it seems that while pre-operative anemia and a longer CPB time were strong determinants for early mortality in elderly patients, long term mortality was more importantly related to the degree of LV diastolic dysfunction, raised left atrial pressure and the presence of pulmonary hypertension. These results are compatible with Gjertsson's finding in highlighting the role of LV diastolic dysfunction after AVR for AS in predicting late mortality [29]. The non-survivors of our elderly AS patients had higher E/A ratios, shorter DT, more frequent atrial fibrillation and higher PASP than those survived.…”

Section: Predictors Of Long Term Mortality In Elderly As Patients Witsupporting

confidence: 94%

Early and long-term survival after aortic valve replacement in septuagenarians and octogenarians with severe aortic stenosis

Ding

Lam

Pepper

et al. 2010

International Journal of Cardiology

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Section: Predictors Of Long Term Mortality In Elderly As Patients Witsupporting

confidence: 94%

Early and long-term survival after aortic valve replacement in septuagenarians and octogenarians with severe aortic stenosis

Ding

Lam

Pepper

et al. 2010

International Journal of Cardiology

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“…Previous studies suggested that LV diastolic dysfunction often persists postoperatively despite a reduction in LV mass (LVM) and is related to worse outcome in patients with severe AS. 3 This finding suggests the hypothesis that LV diastolic function (DF) improvement positively affects prognosis in patients undergoing TAVI. However, the changes in DF following TAVI have received MAD Predicts Post-TAVI DF Improvement thirds graded as 3+.…”

mentioning

confidence: 60%

Impact of Mitral Annular Displacement on Left Ventricular Diastolic Function Improvement After Transcatheter Aortic Valve Implantation

Utsunomiya

Mihara

Itabashi

et al. 2017

Circ J

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less attention than LV systolic function. [4][5][6] Movement of the mitral annulus towards the LV apex, which is referred to as mitral annular displacement (MAD), has been demonstrated as a result of the contraction of longitudinally oriented fibers across the LV wall. 7 Recent studies investigating the LV remodeling process induced by AS consistently indicated the importance of early histological changes in endocardial tissue such as interstitial fibrosis. 8-11 MAD may reflect histological changes in endocardial tissue that can potentially depress longitudinal function. Therefore, in the present study, we sought to examine the serial changes in DF after TAVI, investigate the long-term clinical and hemodynamic effects of post-TAVI DF improvement, and identify its determinants, focusing on MAD representing longitudinal myocardial function.T ranscatheter aortic valve implantation (TAVI) improves survival in patients with symptomatic severe aortic stenosis (AS) who are considered at high surgical risk or who have contraindications for surgery. 1 In recent, large TAVI registry, however, approximately 15% of patients were rehospitalized because of heart failure during the first year despite relief of valvular obstruction. 2 One of the potential factors related to heart failure following TAVI is left ventricular (LV) diastolic dysfunction. Previous studies suggested that LV diastolic dysfunction often persists postoperatively despite a reduction in LV mass (LVM) and is related to worse outcome in patients with severe AS. 3 This finding suggests the hypothesis that LV diastolic function (DF) improvement positively affects prognosis in patients undergoing TAVI. However, the changes in DF following TAVI have received

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“…It has been reported that advanced diastolic dysfunction indirectly reflects non-reversible structural myocardial abnormalities, although a reduced LV systolic function often reflects the after load excess in patients with AS. 42 We speculate that diastolic function deteriorates with old age, and is exacerbated by AS, and that diastolic dysfunction in octogenarians with AS might reflect non-reversible myocardial impairment in our study.…”

Section: Serial Changes In Echocardiographic Parametersmentioning

confidence: 91%

Impact of Ejection Fraction on Long-Term Outcome After Elective Aortic Valve Replacement in Octogenarians With Aortic Stenosis

Shibayama

Watanabe

Tabata

et al. 2012

Circ J

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Background: Aortic stenosis (AS) is increasingly common in the elderly population. A recent invention of transcatheter aortic valve implantation tends to tilt the risk-benefit balance to favor earlier elective intervention for AS. Hence, decision making for elective intervention in octogenarians gradually becomes important. However, the outcome after elective aortic valve replacement (eAVR) has not been evaluated adequately. This study aimed to identify risk factors after eAVR in octogenarians and investigate their influence on long-term outcome. Methods and Results:One hundred and thirty-seven consecutive Japanese octogenarians with AS who underwent eAVR were studied. The mean follow-up period was 35±22 (range, 0-88) months. Long-term overall survival rates after eAVR were 92.0%, 85.2% and 75.5% at 1, 3 and 5 years, respectively. Cox proportional hazards model identified age [hazard ratio (HR) 1.23; 95% confidence interval (CI) 1.07-1.43; P<0.01)] and ejection fraction (EF) <50% (HR 3.38; 95%CI 1.34-8.52; P<0.01) as the risk factors of mortality. Post-eAVR survival rates in octogenarians with an EF ≥50% and <50% were 97.3% and 70.4% at 1 year, 90.1% and 65.3% at 3 years, and 84.3% and 39.2% at 5 years, respectively (P<0.0001). Conclusions:Octogenarians with preserved LV systolic function before surgery have favorable long-term survival after eAVR. However, an EF <50% influences the mortality in octogenarian patients. Therefore, eAVR should be considered for octogenarians with AS before the progression of LV impairment. Methods Study PopulationA retrospective study was conducted with 137 consecutive Japanese octogenarians who underwent eAVR for AS between July 2004 and October 2010 at the Department of Cardiovascular Surgery of the Sakakibara Heart Institute, Tokyo, Japan. Preoperative demographic and perioperative data were retrieved from our computerized database. The primary end point was survival, which was obtained by reviewing inpatient records and follow-up records at outpatient clinics attended by discharged patients, and telephone interviews for a longer term outcome of 1 year or longer after surgery. This study was approved by the human ethics committee of the Sakakibara Heart Institute. Informed consent regarding participation in any clinical research was obtained from all subjects through the Sakakibara Heart Integrative Profile when patients were admitted to our hospital, and their data was available for this study. EchocardiographyComprehensive 2D and Doppler transthoracic echocardiography was performed at the Sakakibara Heart Institute in all patients within 2 months before and 1 week after AVR. A midterm follow-up echocardiography was performed at random from 3 months to 1 year after hospital discharge. A long-term follow-up echocardiography was performed routinely at 1 year after and beyond.Peak transaortic velocity (Vp) and mean transaortic pressure gradient (MPG) were measured by continuous wave Doppler using a multiwindow approach. The aortic valve area (AVA) and actual effective orifice are...

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Preoperative Moderate to Severe Diastolic Dysfunction: A Novel Doppler Echocardiographic Long-term Prognostic Factor in Patients With Severe Aortic Stenosis

Cited by 30 publications

References 0 publications

Early and long-term survival after aortic valve replacement in septuagenarians and octogenarians with severe aortic stenosis

Early and long-term survival after aortic valve replacement in septuagenarians and octogenarians with severe aortic stenosis

Impact of Mitral Annular Displacement on Left Ventricular Diastolic Function Improvement After Transcatheter Aortic Valve Implantation

Impact of Ejection Fraction on Long-Term Outcome After Elective Aortic Valve Replacement in Octogenarians With Aortic Stenosis

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