Key result
An abnormal aorto-ventricular index (< 0.5 mmHg/beats per minute) following TAVR was independently associated with increased intermediate-term mortality (HR 1.5) regardless of baseline diastolic dysfunction.
Why the study?
Abnormal invasive hemodynamics postTAVR is associated with poor survival, but the underlying mechanism and whether diastolic dysfunction modifies this association remain unknown.
Does an abnormal aorto-ventricular index post-TAVR predict intermediate-term mortality irrespective of baseline diastolic dysfunction in TAVR patients?
Cohort (n=390)
Single-blind
No
Does an abnormal aorto-ventricular index post-TAVR predict intermediate-term mortality irrespective of baseline diastolic dysfunction in TAVR patients?
Hazard Ratio: 1.5 (95% CI 1.1–2.1)
Absolute Event Rate: 46% vs 31%
p-value: p=0.017
A low aorto-ventricular index post-TAVR is an independent predictor of intermediate-term mortality, regardless of baseline diastolic dysfunction.
Abnormal post-TAVR AVi was associated with higher mortality independent of diastolic dysfunction; extends hemodynamic data but remains hypothesis-generating.
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.
No takes yet. Share an insight, caveat, or question.
Bavry et al. (2020) conducted a cohort in Aortic stenosis undergoing transcatheter aortic valve replacement (n=390). Abnormal aorto-ventricular index (< 0.5 mmHg/beats per minute) vs. Normal aorto-ventricular index (≥ 0.5 mmHg/beats per minute) was evaluated on All-cause mortality up to 5 years after TAVR (HR 1.5, 95% CI 1.1 to 2.1, p=0.017). An abnormal aorto-ventricular index (< 0.5 mmHg/beats per minute) following TAVR was independently associated with increased intermediate-term mortality (HR 1.5) regardless of baseline diastolic dysfunction.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: