title: Left ventricular stiffness predicts outcome in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Assessment of the prognostic role of left ventricular stiffness (LVS) in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  We performed a complete two-dimensional transthoracic echocardiographic study before and after TAVI in patients with severe AS at high surgical risk. In order to assess LVS, we measured LV end-diastolic pressure (EDP) invasively during TAVI and LV end-diastolic volume (EDV) by means of echocardiography. We defined LVS as the EDV indexed by body surface area at an EDP of 20 mm Hg (EDVI20). Our aim was to assess the impact of LVS on one-year all-cause mortality after TAVI.
  
  
  RESULTS
  One hundred sixty-six patients undergoing TAVI (64% female; mean age 82.7 ± 5.1 years) were enrolled. Seven patients died within the first 30 days after TAVI and 21 within 1 year. Overall follow-up duration was 580 ± 478 days. At multivariate analysis, independent predictors of 1-year all-cause mortality were moderate-to-severe paravalvular leak (PVL; HR 4.7, 95% confidence interval [CI] 1.9-11, P=.0003), female gender (HR 3.5, 95% CI 1.0-12, P=.045), and EDVI20(HR 0.94, 95% CI 0.90-0.98, P=.015). In particular, patients with higher LVS (EDVI20≤48 mL/m2) had a 1-year mortality of 26.9% vs 7.4% in patients with lower LVS (EDVI20>48 mL/m2; HR 4.2, 95% CI 1.6-10.6, P=.0007). Patients with higher LVS who developed moderate-to-severe PVL had the worst outcome (incremental chi-square test, P=.014).
  
  
  CONCLUSIONS
  In patients with AS, an increased LVS has a negative prognostic impact. Development of significant PVL in patients with higher LVS had an incremental adverse effect.
authors: Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa, Pisa, Italy.
authors: Lorenzo
authors: L
authors: Conte
authors: Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa, Pisa, Italy.
authors: Iacopo
authors: I
authors: Fabiani
authors: Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa, Pisa, Italy.
authors: Nicola R
authors: NR
authors: Pugliese
authors: Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa, Pisa, Italy.
authors: Cristina
authors: C
authors: Giannini
authors: Department of Internal Medicine, Hospital Riuniti Palermo, Palermo, Italy.
authors: Salvatore
authors: S
authors: La Carruba
authors: Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa, Pisa, Italy.
authors: Marco
authors: M
authors: Angelillis
authors: Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa, Pisa, Italy.
authors: Paolo
authors: P
authors: Spontoni
authors: Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa, Pisa, Italy.
authors: Marco
authors: M
authors: De Carlo
authors: Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa, Pisa, Italy.
authors: Anna Sonia
authors: AS
authors: Petronio
authors: Department of Surgical, Medical, Molecular Pathology and Critical Area, Cisanello Hospital, University of Pisa, Pisa, Italy.
authors: Vitantonio
authors: V
authors: Di Bello
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: aortic stenosis; aortic valve replacement; diastolic function; left ventricular end-diastolic pressure; left ventricular stiffness