The relationship between baseline diastolic dysfunction and postimplantation invasive hemodynamics with transcatheter aortic valve replacement.

Bavry, Anthony A; Okuno, Taishi; Aalaei-Andabili, Seyed Hossein; Kumbhani, Dharam J; Stortecky, Stefan; Asami, Masahiko; Lanz, Jonas; Windecker, Stephan; Pilgrim, Thomas (2020). The relationship between baseline diastolic dysfunction and postimplantation invasive hemodynamics with transcatheter aortic valve replacement. Clinical cardiology, 43(12), pp. 1428-1434. Wiley 10.1002/clc.23457

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BACKGROUND

Abnormal invasive hemodynamics after transcatheter aortic valve replacement (TAVR) is associated with poor survival; however, the mechanism is unknown.

HYPOTHESIS

Diastolic dysfunction will modify the association between invasive hemodynamics postTAVR and mortality.

METHODS

Patients with echocardiographic assessment of diastolic function and postTAVR invasive hemodynamic assessment were eligible for the present analysis. Diastology was classified as normal or abnormal (Stages 1 to 3). The aorto-ventricular index (AVi) was calculated as the difference between the aortic diastolic and the left ventricular end-diastolic pressure divided by the heart rate. AVi was categorized as abnormal (AVi < 0.5 mmHg/beats per minute) or normal (≥ 0.5 mmHg/beats per minute).

RESULTS

From 1339 TAVR patients, 390 were included in the final analysis. The mean follow-up was 3.3 ± 1.7 years. Diastolic dysfunction was present in 70.9% of the abnormal vs 55.1% of the normal AVi group (P < .001). All-cause mortality was 46% in the abnormal vs 31% in the normal AVi group (P < .001). Adjusted hazard ratio (HR) for AVi < 0.5 mmHg/beats per minute vs AVi ≥0.5 mmHg/beats per minute for intermediate-term mortality was (HR = 1.5, 95% confidence interval [CI] 1.1 to 2.1, P = .017). This association was the same among those with normal diastolic function and those with diastolic dysfunction (P for interaction = .35).

CONCLUSION

Diastolic dysfunction is prevalent among TAVR patients. Low AVi is an independent predictor for poor intermediate-term survival, irrespective of co-morbid diastolic dysfunction.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Okuno, Taishi; Stortecky, Stefan; Asami, Masahiko; Lanz, Jonas; Windecker, Stephan and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0160-9289

Publisher:

Wiley

Language:

English

Submitter:

Nadia Biscozzo

Date Deposited:

08 Jan 2021 13:24

Last Modified:

08 Jan 2021 13:33

Publisher DOI:

10.1002/clc.23457

PubMed ID:

32960991

Uncontrolled Keywords:

aortic stenosis aorto-ventricular index diastolic dysfunction filling pressures invasive hemodynamics prognosis transcatheter aortic valve replacement

BORIS DOI:

10.7892/boris.147547

URI:

https://boris.unibe.ch/id/eprint/147547

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