title: Prognostic Importance of Diastolic Dysfunction in Relation to Post Procedural Aortic Insufficiency in Patients Undergoing Transcatheter Aortic Valve Replacement.
abstract: OBJECTIVE
  We sought to examine whether baseline diastolic dysfunction (DD) is associated with increased mortality in patients who develop aortic insufficiency (AI) after transcatheter aortic valve replacement (TAVR).
  
  
  BACKGROUND
  Significant post-TAVR AI is associated with increased mortality, likely secondary to adverse hemodynamics secondary to volume overload and decreased LV compliance from chronic pressure overload. However, the effect of baseline DD on outcomes of patients with post-TAVR AI has not been studied.
  
  
  METHODS
  A total of 195 patients undergoing TAVR were included in the study. Patients with moderate-to-severe mitral stenosis, prior mitral valve replacement or atrial fibrillation were excluded. DD was classified at baseline by a 2-step approach as recommended by the American Society of Echocardiography while AI was evaluated 30 days post-TAVR. Follow up data up to 2 years post-TAVR was used in survival analysis.
  
  
  RESULTS
  Patients with severe baseline DD who developed ≥mild post-TAVR AI had increased mortality compared to all other patients (HR = 3.89, CI: 1.76-8.6, P = 0.001), which remained significant after adjusting for post-TAVR AI, pre-TAVR AI, baseline mitral regurgitation, ejection fraction, pulmonary artery pressure, creatinine clearance and history of stroke.
  
  
  CONCLUSIONS
  Even mild post-TAVR AI may have a negative impact on outcomes of patients with underlying severe DD. © 2016 Wiley Periodicals, Inc.
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Department of Internal Medicine, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.
authors.forename: Polydoros N
authors.initials: PN
authors.lastname: Kampaktsis
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark.
authors.forename: Casper N
authors.initials: CN
authors.lastname: Bang
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: S
authors.initials: S
authors.lastname: Chiu Wong
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Anesthesiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Nikolaos J
authors.initials: NJ
authors.lastname: Skubas
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Harsimran
authors.initials: H
authors.lastname: Singh
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Voudris
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Department of Internal Medicine, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.
authors.forename: Amiran
authors.initials: A
authors.lastname: Baduashvili
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Pastella
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Swaminathan
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Kaple
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Minutello
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Luke
authors.initials: L
authors.lastname: Kim
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Hriljac
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Fay
authors.initials: F
authors.lastname: Lin
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Geoffrey S
authors.initials: GS
authors.lastname: Bergman
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Arash
authors.initials: A
authors.lastname: Salemi
authors.affiliation: William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.|Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D003971:Diastole; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: aortic valve disease; diastolic dysfuntion; transcatheter valve implantation