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Impact of High Baseline Left Ventricular Filling Pressure on Transcatheter Aortic Valve Replacement Outcomes in

Vien T Truong1, Wojciech Mazur2, Cassady Palmer2

  • 1The Heart and Vascular Center and The Lindner Research Center, The Christ Hospital, Cincinnati, Ohio; The Sue and Bill Butler Research Fellow, The Linder Research Center, Cincinnati, Ohio.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|July 7, 2019
PubMed

Insights

Transcatheter aortic valve replacement for aortic stenosis did not immediately improve high left ventricular filling pressures (LVFP). However, LVFP significantly decreased at one year and high baseline LVFP predicted increased mortality.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Diagnostics

Background:

  • Left ventricular filling pressure (LVFP) is a key predictor of cardiovascular outcomes.
  • Estimating LVFP in aortic stenosis patients is challenging due to mitral annular calcification.
  • Transcatheter aortic valve replacement (TAVR) is a treatment for severe aortic stenosis.

Purpose of the Study:

  • To evaluate the impact of TAVR on LVFP in patients with aortic stenosis and mitral annular calcification.
  • To assess the relationship between LVFP and mortality/hospitalization post-TAVR.

Main Methods:

  • Retrospective study of 140 patients with severe aortic stenosis and mitral annular calcification undergoing TAVR.
  • Diastolic function assessed using specific criteria for mitral annular calcification.
  • LVFP categorized as high based on mitral E/A ratio and isovolumic relaxation time.

Main Results:

  • High LVFP was present in 40.7% at baseline and remained similar at 1 month.
  • A significant decrease in high LVFP was observed at 1 year post-TAVR (26.9%, P=0.02).
  • High baseline LVFP was associated with a 2.84-fold increased risk of all-cause mortality (P=0.007).

Conclusions:

  • High baseline LVFP is linked to increased mortality in patients undergoing TAVR for aortic stenosis.
  • LVFP does not improve acutely but shows significant improvement at one year after TAVR.
  • TAVR may improve diastolic function and reduce LVFP over the long term in select patients.
Abstract

Keywords:
All-cause mortalityHospitalizationLV filling pressure

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