The Impact of Left Ventricular Diastolic Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement.

Asami, Masahiko; Lanz, Jonas; Stortecky, Stefan; Räber, Lorenz; Franzone, Anna; Heg, Dik; Hunziker, Lukas; Roost, Eva; Siontis, George CM; Valgimigli, Marco; Windecker, Stephan; Pilgrim, Thomas (2018). The Impact of Left Ventricular Diastolic Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement. JACC. Cardiovascular Interventions, 11(6), pp. 593-601. Elsevier 10.1016/j.jcin.2018.01.240

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OBJECTIVES This study sought to determine the impact of left ventricular (LV) diastolic dysfunction (LVDD) on clinical outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND LV hypertrophy in response to afterload increase promotes the development of LVDD and represents an early stage in the progression to valvular heart failure. METHODS In a consecutive cohort of 777 aortic stenosis patients undergoing TAVR, LVDD was categorized according to the latest guidelines. The primary endpoint was 1-year all-cause mortality. RESULTS There were 545 (70.1%) patients with LVDD. Ninety-eight (18.0%), 198 (36.3%), and 104 (19.1%) patients were classified as LVDD grades I, II, and III, respectively. In 145 (26.6%) patients, LVDD grade could not be determined because of only 1 or 2 discrepant variables. One-year all-cause mortality was higher in patients with LVDD grades I (16.3%; HR: 2.32; 95% CI: 1.15 to 4.66), II (17.9%; HR: 2.58; 95% CI: 1.43 to 4.67), and III (27.6%; HR: 4.21; 95% CI: 2.25 to 7.86) than in those with normal diastolic function (6.9%). The difference in clinical outcome emerged within 30 days, was driven by cardiovascular death, and maintained in a sensitivity analysis of patients with normal systolic LV function. Furthermore, LVDD grades I (HR: 2.36; 95% CI: 1.17 to 4.74), II (HR: 2.58; 95% CI: 1.42 to 4.66), and III (HR: 4.41; 95% CI: 2.37 to 8.20) were independent predictors of 1-year mortality. CONCLUSIONS Advancing stages of LVDD are associated with an incremental risk of all-cause mortality after TAVR, driven by cardiovascular death and taking effect as early as 30 days after the intervention.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Asami, Masahiko; Lanz, Jonas; Stortecky, Stefan; Räber, Lorenz; Franzone, Anna; Heg, Dierik Hans; Hunziker, Lukas; Roost, Eva; Siontis, Georgios; Valgimigli, Marco; Windecker, Stephan and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

09 Mar 2018 14:43

Last Modified:

21 Sep 2018 08:34

Publisher DOI:

10.1016/j.jcin.2018.01.240

PubMed ID:

29501544

Uncontrolled Keywords:

aortic stenosis clinical outcomes diastolic dysfunction echocardiography transcatheter aortic valve replacement

BORIS DOI:

10.7892/boris.112595

URI:

https://boris.unibe.ch/id/eprint/112595

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