The Impact of Left Ventricular Diastolic Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement

Masahiko Asami; Jonas Lanz; Stefan Stortecky; Lorenz Räber; Anna Franzone; Dik Heg; Lukas Hunziker; Eva Roost; George Cm Siontis; Marco Valgimigli; Stephan Windecker; Thomas Pilgrim

doi:10.1016/j.jcin.2018.01.240

The Impact of Left Ventricular Diastolic Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement

JACC Cardiovasc Interv. 2018 Mar 26;11(6):593-601. doi: 10.1016/j.jcin.2018.01.240. Epub 2018 Mar 2.

Authors

Affiliations

¹ Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
² Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland.
³ Department of Cardiac Surgery, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
⁴ Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland. Electronic address: thomas.pilgrim@insel.ch.

PMID: 29501544
DOI: 10.1016/j.jcin.2018.01.240

Abstract

Objectives: This study sought to determine the impact of left ventricular diastolic dysfunction (LVDD) on clinical outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).

Background: Left ventricular (LV) hypertrophy in response to afterload increase promotes the development of LVDD and represents an early stage in the progression to valvular heart failure.

Methods: In a consecutive cohort of 777 aortic stenosis patients undergoing TAVR, LVDD was categorized according to the latest guidelines. The primary endpoint was 1-year all-cause mortality.

Results: There were 545 (70.1%) patients with LVDD. Ninety-eight (18.0%), 198 (36.3%), and 104 (19.1%) patients were classified as LVDD grades I, II, and III, respectively. In 145 (26.6%) patients, LVDD grade could not be determined because of only 1 or 2 discrepant variables. One-year all-cause mortality was higher in patients with LVDD grades I (16.3%; adjusted hazard ratio [HR]_adj: 2.32; 95% confidence interval [CI]: 1.15 to 4.66), II (17.9%; HR_adj: 2.58; 95% CI: 1.43 to 4.67), and III (27.6%; HR_adj: 4.21; 95% CI: 2.25 to 7.86) than in those with normal diastolic function (6.9%). The difference in clinical outcome emerged within 30 days, was driven by cardiovascular death, and maintained in a sensitivity analysis of patients with normal systolic LV function. Furthermore, LVDD grades I (HR_adj: 2.36; 95% CI: 1.17 to 4.74), II (HR_adj: 2.58; 95% CI: 1.42 to 4.66), and III (HR_adj: 4.41; 95% CI: 2.37 to 8.20) were independent predictors of 1-year mortality.

Conclusions: Advancing stages of LVDD are associated with an incremental risk of all-cause mortality after TAVR, driven by cardiovascular death and taking effect as early as 30 days after the intervention.

Keywords: aortic stenosis; clinical outcomes; diastolic dysfunction; echocardiography; transcatheter aortic valve replacement.

MeSH terms

Aged
Aged, 80 and over
Aortic Valve / diagnostic imaging
Aortic Valve / physiopathology
Aortic Valve / surgery*
Aortic Valve Stenosis / diagnostic imaging
Aortic Valve Stenosis / mortality
Aortic Valve Stenosis / physiopathology
Aortic Valve Stenosis / surgery*
Cause of Death
Echocardiography, Doppler
Female
Humans
Hypertrophy, Left Ventricular / diagnostic imaging
Hypertrophy, Left Ventricular / mortality
Hypertrophy, Left Ventricular / physiopathology*
Male
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Transcatheter Aortic Valve Replacement* / adverse effects
Transcatheter Aortic Valve Replacement* / mortality
Treatment Outcome
Ventricular Dysfunction, Left / diagnostic imaging
Ventricular Dysfunction, Left / mortality
Ventricular Dysfunction, Left / physiopathology*
Ventricular Function, Left*
Ventricular Remodeling