Impact of Mitral Annular Displacement on Left Ventricular Diastolic Function Improvement After Transcatheter Aortic Valve Implantation

Abstract

less attention than LV systolic function. [4][5][6] Movement of the mitral annulus towards the LV apex, which is referred to as mitral annular displacement (MAD), has been demonstrated as a result of the contraction of longitudinally oriented fibers across the LV wall. 7 Recent studies investigating the LV remodeling process induced by AS consistently indicated the importance of early histological changes in endocardial tissue such as interstitial fibrosis. 8-11 MAD may reflect histological changes in endocardial tissue that can potentially depress longitudinal function. Therefore, in the present study, we sought to examine the serial changes in DF after TAVI, investigate the long-term clinical and hemodynamic effects of post-TAVI DF improvement, and identify its determinants, focusing on MAD representing longitudinal myocardial function.T ranscatheter aortic valve implantation (TAVI) improves survival in patients with symptomatic severe aortic stenosis (AS) who are considered at high surgical risk or who have contraindications for surgery. 1 In recent, large TAVI registry, however, approximately 15% of patients were rehospitalized because of heart failure during the first year despite relief of valvular obstruction. 2 One of the potential factors related to heart failure following TAVI is left ventricular (LV) diastolic dysfunction. Previous studies suggested that LV diastolic dysfunction often persists postoperatively despite a reduction in LV mass (LVM) and is related to worse outcome in patients with severe AS. 3 This finding suggests the hypothesis that LV diastolic function (DF) improvement positively affects prognosis in patients undergoing TAVI. However, the changes in DF following TAVI have received

Echocardiographic Assessment of Diastolic Dysfunction in Elderly Patients with Severe Aortic Stenosis Before and After Aortic Valve Replacement

“…To a smaller extent, age might reduce relaxation properties in higher age groups, however, most of the diastolic parameters were not different between the two age groups ≥ 80 and <80 years in the present study. Even though the present study represents an older patient population with higher degree of AS compared to Steines and other younger study populations (2,7,19,21), we found a similar reduction of e´. Our results stress the predominance of factors other than age like LV hypertrophy, changed LV stiffness and increased afterload as the main reasons for decreased relaxation properties in AS patients.…”

“…Even though e´ increases after TAVR/SAVR (7,19,(21)(22)(23), average e´ stayed lower than 10 cm/s in 90% of postoperative AS patients, indicating persistent impaired relaxation also after afterload reduction with AVR. Postoperatively, relaxation velocities in the lateral but not septal wall were signi cantly higher than pre-operative values, suggesting regionally inhomogeneous response to reduced afterload.…”

“…These ndings point to afterload dependent, reversible reduction of contraction and relaxation velocities of the lateral wall, whereas the bulky, structurally changed septum of hypertensive ventricles( 25) have less ability to recover. The majority of previous studies report a similar degree of diastolic dysfunction in AS patients with reduced recovery of relaxation properties (7,19,(21)(22)(23), while only one study could be identi ed describing normalized E/e´, e´ and LA volume post TAVR (26).…”

“…We used NT-proBNP as a surrogate marker of increased lling pressure, as previously practiced in other studies (17,19). Even though NT-proBNP correlates well with diastolic pressures, it is not known whether age alone increases proBNP.…”

Echocardiographic assessment of diastolic dysfunction in elderly patients with severe aortic stenosis before and after aortic valve replacement

“…Results of our study and previous investigations [ 5 , 20 , 22 ] on diastolic parameters in AS, indicate that most AS LVs predominantly display signs of impaired relaxation. This is reflected by low e′, which increases after TAVR/SAVR, though without complete normalization [ 10 , 23 ].…”