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Impact of Baseline Left Ventricular Diastolic Dysfunction in Patients With Severe Aortic Stenosis Undergoing

Edward Koifman1, Diego Medvedofsky2, Romain Didier2

  • 1Section of Cardiology, MedStar Heart and Vascular Institute at MedStar Washington Hospital Center, Washington, District of Columbia; Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of The Negev, Be'er Sheva, Israel.

The American Journal of Cardiology
|November 19, 2019
PubMed

Insights

Patients with grade III diastolic dysfunction (DD) face higher mortality after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS). DD grade improved post-TAVI in some patients, suggesting potential benefits from earlier intervention.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiac Surgery

Background:

  • Severe aortic stenosis (AS) is a significant cardiovascular condition.
  • Diastolic dysfunction (DD) is common in AS patients undergoing transcatheter aortic valve implantation (TAVI).
  • The prognostic impact of pre-procedural DD grade on TAVI outcomes requires further elucidation.

Purpose of the Study:

  • To assess the impact of diastolic dysfunction (DD) grade on 1-year survival in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).
  • To evaluate changes in DD grade post-TAVI.

Main Methods:

  • Retrospective analysis of 606 patients with severe AS undergoing TAVI.
  • DD grading performed according to 2016 ASE/EACVI guidelines.
  • 1-year survival analyzed using Kaplan-Meier and Cox proportional hazard models.

Main Results:

  • Of 394 patients with sufficient data, 77 had grade I, 191 grade II, 60 grade III, and 66 indeterminate DD.
  • Higher DD grade correlated with increased atrial fibrillation, BNP, pulmonary artery systolic pressure, and LV mass.
  • Grade III DD was independently associated with significantly higher 1-year mortality post-TAVI.
  • DD grade improved in patients with pre-existing grades II and III DD post-TAVI.

Conclusions:

  • Severe AS patients with grade III DD have a higher risk of 1-year mortality after TAVI.
  • Diastolic dysfunction can improve after TAVI in patients with moderate to severe DD.
  • Earlier intervention for AS in the context of DD may offer survival benefits.

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