title: Impact of Mitral Annular Displacement on Left Ventricular Diastolic Function Improvement After Transcatheter Aortic Valve Implantation.
abstract: The clinical significance of left ventricular (LV) diastolic function (DF) improvement after transcatheter aortic valve implantation (TAVI) is not fully elucidated. We sought to investigate the long-term clinical and hemodynamic effects of post-TAVI DF improvement and to identify its determinants.
  
  
  
  Clinical and serial echocardiographic data before and after TAVI were retrospectively reviewed together with measurement of mitral annular displacement (MAD) representing longitudinal myocardial function in 98 patients with severe aortic stenosis and ejection fraction >55%. DF grade was determined as 0-III according to the current guideline. Patients with ≥1-grade improvement in DF at 1 year (n=59, 60%) showed a better recovery of New York Heart Association functional class, plasma B-type natriuretic peptide level, stroke volume index, and averaged e', and a greater decrease in systolic pulmonary artery pressure than those without DF improvement (all P<0.05). Coronary artery disease (odds ratio (OR), 0.30; 95% confidence interval (CI), 0.11-0.84; P=0.022) and averaged MAD (per 2.5 mm increase; OR, 4.11; 95% CI, 2.18-7.72; P<0.001) were predictors of post-TAVI DF improvement. An averaged MAD cutoff value of 10.7 mm discriminated cases of improvement with a sensitivity of 88% and specificity of 64%.
  
  
  
  Post-TAVI DF improvement may be associated with preserved LV longitudinal function and when present may be accompanied by more favorable clinical and hemodynamic changes.
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Utsunomiya
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Mihara
authors.forename: Yuji
authors.initials: Y
authors.lastname: Itabashi
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D020097:Natriuretic Peptide, Brain