Key result
In patients with severe aortic stenosis undergoing transcatheter aortic valve implantation, 44% of left ventricular diastolic dysfunction assessments were reclassified when applying the 2016 guidelines compared to the 2009 guidelines.
Why the study?
The study was designed to evaluate the detailed dynamic change of left ventricular diastolic function after TAVI in patients with AS and compare classification schemes from the 2009 ASE/EAE and 2016 ASE/EACVI recommendations.
Observational (n=35)
No
The 2016 ASE/EACVI guidelines reclassify a significant proportion of post-TAVI patients compared to the 2009 guidelines, generally showing more patients with improved diastolic function.
Guideline discordance reclassifies LVDF in many post-TAVI patients; leaves open which scheme best tracks benefit or guides care.
BACKGROUND: To evaluate the detailed dynamic change of left ventricular diastolic function (LVDF) by echocardiography in aortic stenosis (AS) patients receiving transcatheter aortic valve implantation (TAVI) and compare LVDF classification according to 2009 ASE/EAE and 2016 ASE/EACVI recommendations. METHODS: Thirty-five AS patients receiving TAVI underwent echocardiography the day before operation (PRE), on the third day (3D), in the first-month (1 M) and the six-month (6 M) after TAVI. LVDF was analyzed using 2D and doppler imaging to get parameters including E/A, E/e', isovolumic relaxation time (IVRT), deceleration time, LA area, LA volume index (LAVI) and systolic tricuspid regurgitation velocity (TR). LVDF classification was evaluated four times for each patient according to 2009 and 2016 recommendations respectively and the results were compared. RESULTS: The decrease of IVRT and TR occurred immediately post surgery up to 1-month. Improvement of E/e' occurred late from 3-day to 1-month. LA area and LAVI decreased continuously shortly after operation till 6-month. Forty-four percent (62/140) by 2009 recommendations were reclassified with different grades when using 2016 guidelines. Comparing PRE and 6 M, with 2009 guidelines, 19 patients improved 1 grade, 8 patients improved 2 grades; with 2016 guidelines, 9 patients improved 1 grade, 13 patients improved 2 grades, 1 patient improved 3 grades. CONCLUSIONS: The conventional 2D echocardiography could effectively reflect variation process of LVDF in AS patients after TAVI. For LVDD classification, obvious differences resulted by the 2009 and updated recommendations were found, and more patients can be regarded as benefiting from TAVI by 2016.
No takes yet. Share an insight, caveat, or question.
Guo et al. (2020) conducted an observational in Severe symptomatic aortic stenosis (n=35). Transcatheter aortic valve implantation (TAVI) vs. Pre-operative baseline was evaluated on Reclassification of left ventricular diastolic dysfunction grades (2016 vs 2009 guidelines). In patients with severe aortic stenosis undergoing transcatheter aortic valve implantation, 44% of left ventricular diastolic dysfunction assessments were reclassified when applying the 2016 guidelines compared to the 2009 guidelines.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: