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Impact of diastolic dysfunction on long-term mortality and quality of life after transcatheter aortic valve

Mahesh Anantha-Narayanan1, Umair Malik1, Mackenzi Mbai1,2

  • 1Department of Medicine, Division of Cardiology, University of Minnesota Medical School, Minneapolis, Minnesota.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 17, 2019
PubMed

Insights

Diastolic dysfunction (DD) and elevated NT-pro BNP levels predict worse long-term survival in patients undergoing transcatheter aortic valve replacement (TAVR). However, quality of life improves similarly across all DD grades post-TAVR.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Conflicting data exists regarding the prognostic impact of diastolic dysfunction (DD) in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
  • Assessing DD and its relationship with outcomes is crucial for optimizing TAVR patient management.

Purpose of the Study:

  • To investigate the association between preoperative diastolic dysfunction (DD) and NT-pro BNP levels with long-term mortality and quality of life after transcatheter aortic valve replacement (TAVR).

Main Methods:

  • A cohort of 222 patients undergoing TAVR had preoperative echocardiography and NT-pro BNP assessment.
  • Diastolic dysfunction (DD) was graded using current American Society of Echocardiography guidelines.
  • Long-term survival and health status (KCCQ-12) were monitored post-TAVR.

Main Results:

  • Advanced (Grades II-III) and indeterminate DD were linked to higher NT-pro BNP levels and increased long-term mortality (25-28% vs. 5%, p=0.02).
  • Patients with advanced DD had worse baseline quality of life but demonstrated similar improvements post-TAVR compared to those without or with mild DD.
  • Elevated NT-pro BNP levels also correlated with increased mortality.

Conclusions:

  • Preoperative NT-pro BNP levels and echocardiographic findings of indeterminate or advanced diastolic dysfunction (DD) are associated with increased long-term mortality following TAVR.
  • Despite poorer prognosis, patients with DD experience comparable improvements in quality of life after TAVR.
Abstract

Keywords:
DIAS-diastolic dysfunctionHCO-health care outcomesTVI-transcatheter valve implantation

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