title: Impact of left ventricular filling parameters on outcome of patients undergoing trans-catheter aortic valve replacement.
abstract: OBJECTIVE
  To assess the impact of left ventricular (LV) filling parameters on outcomes following trans-catheter aortic valve replacement (TAVR).
  
  
  RESULTS
  A total of 526 TAVR patients were compared with 300 patients with severe aortic stenosis (AS) treated conservatively. Clinical variables were collected along with echocardiographic data at baseline, 1 month, and 6 months after study entry. End points included all-cause mortality and the combination of death and heart failure admission. LV filling parameters associated with mortality included reduced A wave velocity (P = 0.005) and shorter deceleration time (DT) (P = 0.0005). DT was superior to all other parameters (P = 0.05) apart from patients with atrial fibrillation in whom E/e' was better. Short DT (<160 ms) was associated with lower survival than long DT (≥220 ms; P = 0.002) or intermediate DT (P = 0.05), even after adjustment for age, gender, stroke volume index (SVI), and co-morbidities. However, patients with short baseline DT exhibited greater improvement in DT, E/A, and systolic pulmonary pressure at follow-up than patients with baseline DT ≥160 ms (P < 0.05 for all time x group interactions). Most importantly, among patients with short DT, TAVR was associated with better survival than conservative treatment (46 ± 7 vs. 28 ± 12% at 3 years, P = 0.05), even after adjustment for age, gender, and SVI (P = 0.05).
  
  
  CONCLUSIONS
  Short DT is an independent predictor of adverse outcome following TAVR. Nevertheless, LV filling parameters improve in most patients post TAVR, and TAVR is associated with improved survival compared with conservative therapy, even in patients with evidence of elevated LV filling. Thus, evidence of elevated LV filling should not be viewed as a contraindication for TAVR.
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Judith
authors.initials: J
authors.lastname: Kramer
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Simon
authors.initials: S
authors.lastname: Biner
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Ghermezi
authors.affiliation: Heart and Vascular Institute Philadelphia, Einstein Medical Center, PA, USA.
authors.forename: Gregg S
authors.initials: GS
authors.lastname: Pressman
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Hezzi
authors.initials: H
authors.lastname: Shmueli
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Jason
authors.initials: J
authors.lastname: Shimiaie
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Arie
authors.initials: A
authors.lastname: Finkelstein
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Banai
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Arie
authors.initials: A
authors.lastname: Steinvil
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Eric
authors.initials: E
authors.lastname: Buffle
authors.affiliation: Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Galit
authors.initials: G
authors.lastname: Aviram
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Meirav
authors.initials: M
authors.lastname: Ingbir
authors.affiliation: Division of Cardiovascular Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Nahum
authors.initials: N
authors.lastname: Nesher
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.|Division of Cardiovascular Diseases and Internal Medicine, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel.
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D015331:Cohort Studies; D016208:Databases, Factual; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015588:Observer Variation; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000401:mortality*; D016896:Treatment Outcome
keywords: deceleration time (DT); left atrium (LA); left ventricle (LV); trans-catheter aortic valve replacement (TAVR)