Key result
Change in LVDD severity was significantly associated with health status 1 year after TAVR (p=0.007), with worsened LVDD resulting in a 4.0-point lower improvement in KCCQ-OS score compared to unchanged LVDD.
Why the study?
Baseline left ventricular diastolic dysfunction is associated with poor health status before TAVR, but the relationship between post-TAVR changes in diastolic dysfunction severity and health status outcomes remains to be examined.
Is a change in left ventricular diastolic dysfunction severity associated with a change in health status 1 year following TAVR in patients with severe aortic stenosis?
Cohort (n=1,100)
Yes
Is a change in left ventricular diastolic dysfunction severity associated with a change in health status 1 year following TAVR in patients with severe aortic stenosis?
Changes in diastolic function correlate with the magnitude of patient-reported health status optimization one year after TAVR.
LVDD changes after TAVR associate with health status gains; hypothesis-generating for whether diastolic function is a modifiable target.
BackgroundBaseline left ventricular diastolic dysfunction (LVDD) is associated with poor health status in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but health status improvement after TAVR appears similar across all grades of LVDD. Here, we aim to examine the relationship between changes in LVDD severity and health status outcomes following TAVR.MethodsPatients who underwent TAVR and had evaluable LVDD at both baseline and 1 year in the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registries and PARTNER 3 trial were analyzed. LVDD grade was evaluated using echocardiography core lab data and an adapted definition of American Society of Echocardiography guidelines. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score. The association between ΔLVDD severity and ΔKCCQ-OS was examined using linear regression models adjusted for baseline KCCQ-OS.ResultsOf 1100 patients, 724 (65.8%), 283 (25.7%), and 93 (8.5%) had grade 0/1, 2, and 3 LVDD at baseline, respectively. At 1 year, LVDD severity was unchanged in 790 (71.8%) patients, improved in 189 (17.2%), and worsened in 121 (11.0%). Among 376 patients with baseline grade 2 or 3 LVDD, 50.3% had improvement in LVDD. In the overall cohort, KCCQ-OS score improved by 21.9 points at 1 year. There was a statistically significant association between change in LVDD severity (improved, unchanged, and worsened) and ΔKCCQ-OS at 1 year (p = 0.007).ConclusionsChange in LVDD grade was associated with change in health status 1 year following TAVR.
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El‐Zein et al. (2023) conducted a cohort in Severe symptomatic aortic stenosis (n=1,100). Change in left ventricular diastolic dysfunction (LVDD) severity vs. Unchanged LVDD severity was evaluated on Change in Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score at 1 year (MD -4.0, 95% CI -7.1, -0.9, p=0.007). Change in LVDD severity was significantly associated with health status 1 year after TAVR (p=0.007), with worsened LVDD resulting in a 4.0-point lower improvement in KCCQ-OS score compared to unchanged LVDD.
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