title: Acute left ventricle diastolic function improvement after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Data regarding the effects of TAVI on LV after are scarce and conflicting results have been reported immediately after aortic valvuloplasty. This study aimed to determine the acute haemodynamic effects of transcatheter aortic valve implantation (TAVI) in left ventricle (LV) diastolic performance, immediately after aortic valvuloplasty and prosthesis deployment.
  
  
  RESULTS
  Sixty-one patients with severe aortic valve stenosis, and preserved LV systolic function submitted to successful TAVI, were included. All procedures were guided through transoesophageal echocardiography, and parameters of diastolic function were evaluated before and minutes after TAVI. The mean age was 83.5±6 years and mean log EuroSCORE was 18.2±9.4. Before the procedure, all patients presented LV diastolic dysfunction. Immediately after TAVI, fewer patients presented a restrictive pattern [27 (44.3%), before the procedure, vs. 20 (34.4%), after TAVI (P=0.047)], and an increase in E wave deceleration time (211.2±75.5 vs. 252.7±102.3 cm/s, P=0.001), in E wave velocity (109.5±41.2 vs. 120.3±43.6 cm/s, P=0.025), and in isovolumetric relaxation time (83±36.5 vs. 97.1±36.0 ms, P=0.013) was observed. On multivariate analysis of covariance (ANCOVA), adjusting to LV systolic function, heart rate, blood pressure, and haematocrit values, the results remained significant. Patients referred to percutaneous approach had invasive haemodynamic data collected, showing a decrease in LV end-diastolic pressure after valve implantation [18.8±5.7 vs. 14.7±4.7, mean difference -4.1 (95% CI: -5.9; -2.9)]. Patients with a restrictive pattern immediately after TAVI presented a smaller decrease in LV end diastolic pressure (-3.3±4.7) than those with diastolic dysfunction grade I or II (-9.5±4.7; P=0.017).
  
  
  CONCLUSIONS
  This is the first study describing LV diastolic performance during TAVI. Our results show improvement in diastolic function parameters in patients with preserved LV systolic function, immediately after successful TAVI.
authors.affiliation: Cardiovascular Institute, Unit of Methodology of the Investigation and Clinical Epidemiology, Preventive Medicine Department, Hospital Clínico San Carlos, Plaza de Cristo Rey, Madrid 28040, Spain.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gonçalves
authors.forename: Pedro
authors.initials: P
authors.lastname: Marcos-Alberca
authors.forename: Carlos
authors.initials: C
authors.lastname: Almeria
authors.forename: Gisela
authors.initials: G
authors.lastname: Feltes
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodríguez
authors.forename: Rosa Ana
authors.initials: RA
authors.lastname: Hernández-Antolín
authors.forename: Eulogio
authors.initials: E
authors.lastname: Garcia
authors.forename: Luis
authors.initials: L
authors.lastname: Maroto
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernandez Perez
authors.forename: José C
authors.initials: JC
authors.lastname: Silva Cardoso
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: José Luis
authors.initials: JL
authors.lastname: Zamorano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization; D003971:Diastole; D017548:Echocardiography, Transesophageal; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*