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

Edward Koifman, Diego Medvedofsky, Romain Didier, Rebecca Torguson, Zack Jerusalem, Sarkis Kiramijyan, Itsik Ben-Dor, Zuyue Wang, Steven A. Goldstein, Linzhi Xu, Augusto D. Pichard, Lowell F. Satler, Ron Waksman, Federico M. Asch*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

We sought to assess the impact of diastolic dysfunction (DD) grade, as per the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines, on survival of patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI). We included consecutive patients with severe AS who underwent TAVI in our institution. DD grading was determined retrospectively according to the 2016 ASE DD guidelines and categorized to grade I-III and indeterminate grade I-II DD. Comparison of 1-year survival according to DD grade was performed by Kaplan-Meier analysis, and evaluation of DD at 1 year was performed in a subset of patients. Among 606 TAVI patients, 394 (65%) had sufficient data for DD grading. Seventy-seven (20%) had grade I DD, 191 (48%) had grade II, 60 (15%) had grade III, and 66 (17%) had an indeterminate grade between I and II. Baseline characteristics indicate higher rates of atrial fibrillation, brain natriuretic peptide level, pulmonary artery systolic pressure, and indexed left ventricular mass as DD grade increases (all p ≤0.01). In conclusion, comparison of 1-year survival revealed a higher rate of mortality in patients with grade III DD that remained statistically significant following adjustment in a multivariate Cox proportional hazard model. DD grade after TAVI improved in patients with grades II and III. Severe AS patients with grade III DD have higher risk for 1-year mortality after TAVI compared with milder degrees of DD. Further research is warranted to explore a potential benefit for aortic valve therapy at an earlier stage of the disease process.

Original languageEnglish
Pages (from-to)258-263
Number of pages6
JournalAmerican Journal of Cardiology
Volume125
Issue number2
DOIs
StatePublished - 15 Jan 2020
Externally publishedYes

Funding

FundersFunder number
Abbott Structural Heart Ron Waksman
Boston Scientific, Chiesi
Cardiovascular Systems Inc.
Pi-Cardia Ltd.
St. Jude Medical, Medtronic
AMGEN
AstraZeneca
Medtronic
St. Jude Medical
Chiesi Farmaceutici
Boston Scientific Corporation
Philips Oral Healthcare
Biotronik

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