Diastolic Function and Transcatheter Aortic Valve Replacement.
BACKGROUND
Little is known about baseline diastolic dysfunction and changes in diastolic dysfunction grade after transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) and its impact on overall outcomes. The aim of this study was to describe baseline diastolic dysfunction and changes in diastolic dysfunction grade that occur with TAVR and their relationship to mortality and rehospitalization.


METHODS
This was a single-center study evaluating all TAVRs from January 2012 to June 2014. We compared parameters of diastolic dysfunction grade on pre-TAVR and 1 month post-TAVR echocardiograms for all patients undergoing the procedure. Descriptive statistics, Kaplan-Meier time-to-event analysis, and multivariate logistic regression were used.


RESULTS
Of a sample size of 120 patients undergoing TAVR for symptomatic severe AS, 90 were included in the final analysis after excluding significant mitral valve disease. There were improvements in individual parameters of diastolic dysfunction grade such as lateral e' velocity, E/lateral e', and left atrial volume index (nonsignificant trend) in the setting of improvement in aortic valve area and gradients and functional class pre- and post-TAVR. Multivariate analysis revealed that baseline diastolic dysfunction grade, but not post-TAVR or changes in diastolic dysfunction grade, was associated with 1-year death (hazard ratio, 1.163; 95% CI, 1.049-1.277, P = .005) and combined death/cardiovascular hospitalization (hazard ratio, 1.174; 95% CI, 1.032-1.318; P = .018).


CONCLUSIONS
In this single-center retrospective study of patients with symptomatic severe AS who underwent TAVR, several diastolic function parameters improved on echocardiography, but baseline diastolic dysfunction grade remained the most important echocardiographic factor associated with adverse 1-year outcomes.
Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
John E A
JEA
Blair
Scripps Clinic, La Jolla, California.
Prashant
P
Atri
Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois.
Julie L
JL
Friedman
Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois.
James D
JD
Thomas
Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois.
Kent
K
Brummel
Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois.
Ranya N
RN
Sweis
Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois.
Issam
I
Mikati
Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois.
S Chris
SC
Malaisrie
Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois.
Charles J
CJ
Davidson
Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois. Electronic address: jflahert@nmh.org.
James D
JD
Flaherty
D000293:Adolescent; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D015984:Causality; D002641:Chicago / Q000453:epidemiology; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality* / Q000517:prevention & control
Aortic stenosis; Diastolic dysfunction; Transcatheter aortic valve replacement