Impact of left ventricular filling parameters on outcome of patients undergoing trans-catheter aortic valve replacement

Judith Kramer, Simon Biner, Michael Ghermezi, Gregg S. Pressman, Hezzi Shmueli, Jason Shimiaie, Arie Finkelstein, Shmuel Banai, Arie Steinvil, Eric Buffle, Galit Aviram, Meirav Ingbir, Nahum Nesher, Gad Keren, Yan Topilsky

Research output: Contribution to journalArticlepeer-review

Abstract

Aim To assess the impact of left ventricular (LV) filling parameters on outcomes following trans-catheter aortic valve replacement (TAVR). Methods and results A total of 526 TAVR patients were compared with 300 patients with severe aortic stenosis (AS) treated conservatively. Clinical variables were collected along with echocardiographic data at baseline, 1 month, and 6 months after study entry. End points included all-cause mortality and the combination of death and heart failure admission. LV filling parameters associated with mortality included reduced A wave velocity (P = 0.005) and shorter deceleration time (DT) (P = 0.0005). DT was superior to all other parameters (P = 0.05) apart from patients with atrial fibrillation in whom E/e′ was better. Short DT (<160 ms) was associated with lower survival than long DT (≥220 ms; P = 0.002) or intermediate DT (P = 0.05), even after adjustment for age, gender, stroke volume index (SVI), and co-morbidities. However, patients with short baseline DT exhibited greater improvement in DT, E/A, and systolic pulmonary pressure at follow-up than patients with baseline DT ≥160 ms (P < 0.05 for all time x group interactions). Most importantly, among patients with short DT, TAVR was associated with better survival than conservative treatment (46 ± 7 vs. 28 ± 12% at 3 years, P = 0.05), even after adjustment for age, gender, and SVI (P = 0.05). Conclusion Short DT is an independent predictor of adverse outcome following TAVR. Nevertheless, LV filling parameters improve in most patients post TAVR, and TAVR is associated with improved survival compared with conservative therapy, even in patients with evidence of elevated LV filling. Thus, evidence of elevated LV filling should not be viewed as a contraindication for TAVR.

Original languageEnglish
Pages (from-to)304-314
Number of pages11
JournalEuropean Heart Journal Cardiovascular Imaging
Volume18
Issue number3
DOIs
StatePublished - 1 Mar 2017
Externally publishedYes

Keywords

  • deceleration time (DT)
  • left atrium (LA)
  • left ventricle (LV)
  • trans-catheter aortic valve replacement (TAVR)

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