Predictors of improvement in diastolic function after transcatheter aortic valve implantation.
BACKGROUND
Aortic stenosis is associated with concentric left ventricle (LV) hypertrophy or remodeling resulting in impaired diastolic function and elevated left-sided filling pressure. We investigated the changes in LV geometry and LV filling hemodynamics, giving emphasis to parameters associated with changes in diastolic function after transcatheter aortic valve implantation (TAVI).


METHODS
Comprehensive diastolic assessment was performed before and six months after TAVI in 70 patients with severe aortic stenosis. Patients with any degree of mitral stenosis or >mild left-sided valvular regurgitation were excluded.


RESULTS
In the entire cohort six months after TAVI, LV end-diastolic diameter increased (44.1 ± 6 versus 45 ± 6 mm, P = 0.02), whereas LV mass and relative wall thickness (RWT) decreased (270.1 ± 76 versus 245.1 ± 75 g and 0.53 ± 0.15 versus 0.46 ± 0.1, respectively; P < 0.0001 for both). Lateral e' increased (5.8 ± 2 versus 6.6 ± 3 cm/s, P = 0.03) and left atrium (LA) volume, E/e' ratio, and systolic pulmonary pressure decreased (88.1 ± 30 versus 80 ± 28 cc, 18 ± 7.8 versus 16.3 ± 5.5, and 42.7 ± 14.9 versus 38.7 ± 12 mmHg, respectively; P < 0.05 for all), suggesting reduction in LA pressure. The improvement in LA volume and E/e' was almost exclusively seen in patients with LV hypertrophy before TAVI (P < 0.05 both), as opposed to patients with concentric remodeling.


CONCLUSIONS
In our preliminary study, TAVI resulted in LV and LA reverse remodeling, and improved LV relaxation and LA filling pressure in patients with severe aortic stenosis and concentric hypertrophy. Patients with concentric remodeling at baseline seem to have limited improvement in LV diastolic function and filling pressure following TAVI, but larger clinical trials would be required to conclude if they have no improvement at all.
Department of Cardiology, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel. maayan.konigstein@gmail.com.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. maayan.konigstein@gmail.com.
Konigstein
K
Maayan
Department of Cardiology, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Biner
B
Simon
Department of Cardiology, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Topilsky
T
Yan
Department of Cardiology, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abramowitz
A
Yigal
Department of Cardiology, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Havakuk
H
Ofer
Department of Cardiology, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Ben-Assa
BA
Eyal
Department of Cardiology, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Leshem-Rubinow
LR
Eran
Department of Cardiology, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arbel
A
Yaron
Department of Cardiology, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Keren
K
Gad
Department of Cardiology, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Banai
B
Shmuel
Department of Cardiology, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Finkelstein
F
Ariel
Concentric hypertrophy; Concentric remodeling; Diastolic function; Transcatheter aortic valve implantation