Baseline left ventricular diastolic dysfunction affects midterm mortality after transcatheter aortic valve...

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Diagnostics

Background:

• Severe aortic stenosis (AS) necessitates intervention, with transcatheter aortic valve implantation (TAVI) being a primary treatment option.
• Left ventricular (LV) diastolic dysfunction is a common comorbidity in patients with AS.
• The impact of preprocedural LV diastolic dysfunction on outcomes after TAVI requires further clarification.

Purpose of the Study:

• To evaluate the association between preprocedural left ventricular (LV) diastolic dysfunction severity and midterm mortality following TAVI in patients with severe AS.
• To synthesize existing evidence through a meta-analysis to provide a robust assessment of this relationship.

Main Methods:

• A systematic meta-analysis was conducted, searching MEDLINE and EMBASE databases for relevant studies up to September 2019.
• Studies investigating the impact of preprocedural LV diastolic dysfunction on midterm (≥1-year) all-cause mortality after TAVI for AS were included.
• Hazard ratios (HRs) for midterm mortality were extracted and pooled using a random-effects model.

Main Results:

• Ten studies comprising 2380 patients with AS undergoing TAVI were analyzed.
• Higher-grade preprocedural LV diastolic dysfunction was significantly associated with worse midterm all-cause mortality post-TAVI.
• Specific HRs indicated increased mortality risk for grade II vs I (1.15), grade III vs I (1.35), and grade III vs II (1.16), with pooled HR for grade II-III vs I/0-I being 1.34 (P < .00001).

Conclusions:

• Preprocedural left ventricular (LV) diastolic dysfunction is a significant predictor of worse midterm all-cause mortality after TAVI in patients with severe AS.
• The severity of LV diastolic dysfunction correlates with the degree of increased mortality risk.
• These findings underscore the clinical importance of assessing LV diastolic function in the pre-TAVI evaluation.