Prognostic role of diastolic dysfunction in patients undergoing transcatheter aortic valve replacement

Abstract

Objectives: Prior studies have shown that left ventricular diastolic dysfunction (DD) is associated with increased mortality after surgical aortic valve replacement but studies on transcatheter aortic valve replacement (TAVR) are limited and have not taken into account mitral annular calcification (MAC), which limits the use of mitral valve annular tissue Doppler imaging. We performed a single-center retrospective analysis to better evaluate the role of baseline DD on outcomes after TAVR.Methods: After excluding patients with atrial fibrillation, mitral valve prostheses and significant mitral stenosis, 359 consecutive TAVR patients were included in the study. Moderate-to-severe MAC was present in 58% of the patients. We classified patients into severe versus nonsevere DD based on the evaluation of elevated left ventricular filling pressure. The outcome measure was all-cause mortality or heart failure hospitalization.

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

“…Ten eligible studies with a total of 2380 (except for duplicate) patients with AS undergoing TAVI were identified (Table ). A study by Truong et al, which exclusively enrolled patients with AS with concomitant significant mitral annular calcification, was excluded from the present meta‐analysis.…”

“…Extracted and calculated HRs of midterm all‐cause mortality were listed in Table . Kampaktsis et al (the same author) conducted two discrete studies (Kampaktsis‐2017 and Kampaktsis‐2019) in the New York Presbyterian Hospital/Weill Cornell Medical College. From the former study, we extracted an HR per dysfunction grade and calculated HRs for ASE/ESC‐2009 grade II vs I, III vs I, and III vs II dysfunction.…”

“…From the former study, we extracted an HR per dysfunction grade and calculated HRs for ASE/ESC‐2009 grade II vs I, III vs I, and III vs II dysfunction. An HR for ASE/ESC‐2009 grade II‐III vs I dysfunction was available in the former study, and an HR for E/A >1.5 vs ≤1.5 (corresponding to ASE/ESC‐2009 grade III vs I‐II dysfunction) was procurable in the latter study . The HR for E/A >1.5 vs ≤1.5 from the latter study was extracted and then combined in the meta‐analysis because the latter study enrolled more patients than the former study (359 vs 146).…”

“…An HR for ASE/ESC‐2009 grade II‐III vs I dysfunction was available in the former study, and an HR for E/A >1.5 vs ≤1.5 (corresponding to ASE/ESC‐2009 grade III vs I‐II dysfunction) was procurable in the latter study . The HR for E/A >1.5 vs ≤1.5 from the latter study was extracted and then combined in the meta‐analysis because the latter study enrolled more patients than the former study (359 vs 146). Adjusted HRs were available in four studies and unadjusted HRs were procurable in three studies .…”

“…The HR for E/A >1.5 vs ≤1.5 from the latter study was extracted and then combined in the meta‐analysis because the latter study enrolled more patients than the former study (359 vs 146). Adjusted HRs were available in four studies and unadjusted HRs were procurable in three studies . In two studies, the unadjusted HR per average E/e' and that per ASE/EACVI‐2016 grade were statistically nonsignificant in the univariate analysis, and accordingly the average E/e' and the ASE/EACVI‐2016 grade were not entered into the multivariate analysis.…”