Related Experiment Video
Updated: Jun 27, 2026
Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
The prognostic impact of diastolic dysfunction after transcatheter aortic valve replacement: A systematic review and
Nikolaos Stalikas1, Vasileios Anastasiou1, Ioannis Botis1
1AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece.
Insights
Severe diastolic dysfunction (DD) before transcatheter aortic valve replacement (TAVR) significantly increases risks for mortality and major adverse cardiovascular events (MACEs). Echocardiography assessment of DD is crucial for predicting long-term outcomes after TAVR.
Area of Science:
- Cardiology
- Echocardiography
- Interventional Cardiology
Background:
- Diastolic dysfunction (DD) is a known indicator of disease progression in aortic stenosis (AS).
- Worsening pre-operative DD identified via echocardiography correlates with adverse outcomes post-transcatheter aortic valve replacement (TAVR).
Approach:
- A systematic literature review identified studies assessing the prognostic value of severe DD before TAVR.
- A random-effects meta-analysis quantified risks for mortality and major adverse cardiovascular events (MACEs) associated with severe DD.
Key Points:
- Ten studies involving 4,619 patients were analyzed.
- Severe DD independently predicts increased risk of all-cause mortality (adjusted HR=2.35) and MACEs (adjusted HR=2.52) post-TAVR.
- No significant difference in post-TAVR risk was observed based on different diastolic function grading scores.
Conclusions:
- Pre-TAVR severe DD is a critical factor influencing long-term adverse outcomes.
- Echocardiographic assessment of DD is essential for patient risk stratification before TAVR.
Background:
Diastolic dysfunction (DD) is a long-established marker of disease progression in patients with aortic valve stenosis (AS), indicating valvular myocardial damage. Recently, substantial observational data have emerged demonstrating that worse pre-operative DD assessed using echocardiography is associated with adverse long-term clinical outcomes after transcatheter aortic valve replacement (TAVR).
Aim:
To systematically appraise and quantitatively synthesize current evidence on the prognostic impact of echocardiographic severe DD derived by echocardiography before TAVR.
Methods:
A systemic literature review was undertaken in electronic databases to identify studies reporting the predictive value of severe DD in AS subjects undergoing TAVR. A random-effects meta-analysis was conducted to quantify the adjusted and unadjusted hazard ratios (HRs) for all-cause mortality and major adverse cardiovascular events (MACEs) for the presence of severe DD.
Results:
Ten studies were deemed eligible for inclusion. Of those, 9 provided appropriate quantitative data for the meta-analysis, encompassing a total of 4,619 patients. The presence of severe DD was associated with increased risk for all-cause mortality (pooled unadjusted HR=2.56 [1.46-4.48]; p<0.01; I2=76 %) and MACEs (pooled unadjusted HR=1.82 [1.29-2.58]; p<0.01; I2=86 %). When adjusted for clinically-relevant parameters, the presence of severe DD retained independent association with all-cause mortality (pooled adjusted HR=2.35 [1.26-4.37]; p<0.01; I2=79 %) and MACEs (pooled adjusted HR= 2.52 [1.72-3.65]; p<0.01; I2=0 %). In subgroup analysis there was no difference on post-TAVR risk between the use of different diastolic function grading scores.
Conclusion:
Presence of severe DD assessed by echocardiography pre-TAVR is a major determinant of long-term adverse outcomes after the procedure.
More Related Videos
Related Concept Videos
01:22Mitral Valve Prolapse II: Assessment and Management
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
01:27Mitral Stenosis IV: Nursing Management
01:15Aortic Regurgitation I: Introduction
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:25Aortic Regurgitation III: Medical Management