title: Sustained favourable haemodynamics 1 year after TAVI: improvement in NYHA functional class related to improvement of left ventricular diastolic function.
abstract: OBJECTIVE
  Despite expected improvement in left ventricular (LV) systolic and diastolic function after transcatheter aortic valve implantation (TAVI), the complex relationship between pre-existent LV systolic and diastolic function and changes in LV haemodynamics and clinical symptoms have been scarcely investigated. This study investigated the presence of pre-operative LV diastolic dysfunction and its improvement over time after TAVI alongside improvement in New York Heart Association (NYHA) class in high-risk patients with severe aortic stenosis.
  
  
  RESULTS
  The study population (n = 358) was divided into two groups according to baseline LV ejection fraction (LVEF): LVEF < 50% (n = 96) and LVEF ≥ 50% (n = 262). We compared clinical and echocardiographic parameters between groups before TAVI, at 6 and 12 months follow-up. Grade III LV diastolic dysfunction was more frequent in patients with LVEF < 50% compared with patients with LVEF ≥ 50% (50.0 vs. 16.3%, P < 0.001). Systolic and diastolic echocardiographic parameters improved after TAVI together with improvement in NYHA class both in patients with LVEF < 50% (diastolic dysfunction grade ≥2: baseline 100% of patients; 12 months 58.8%, P < 0.001; NYHA III/IV: baseline, 93.8%; 12 months, 9.7%, P < 0.001) and with LVEF ≥ 50% (diastolic dysfunction grade ≥2: baseline, 87.1%; 12 months, 61.2%; NYHA III/IV: baseline, 74.5%; 12 months, 2.6%, P < 0.001). All-cause mortality was comparable between groups.
  
  
  CONCLUSIONS
  TAVI exerts favourable effects on LV systolic and diastolic function with a remarkable improvement in LV diastolic function associated with improvement in NYHA functional class at follow-up. Prognosis at 1 year after TAVI was not influenced by baseline LV diastolic dysfunction both in patients with and without LV systolic dysfunction.
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy manuela.muratori@ccfm.it.
authors.forename: Manuela
authors.initials: M
authors.lastname: Muratori
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Fusini
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Tamborini
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Gripari
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ghulam Ali
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Barbier
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.|Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.|Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Alamanni
authors.affiliation: Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology; D004452:Echocardiography / Q000379:methods; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013318:Stroke Volume / Q000502:physiology*; D015996:Survival Rate; D013599:Systole / Q000502:physiology; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Doppler echocardiography; diastolic function; transcatheter aortic valve implantation