Key result
Post-TAVI diastolic improvement is linked to ~90% lower risk of death or HF hospitalization.
Why the study?
The clinical significance and determinants of left ventricular diastolic function improvement after transcatheter aortic valve implantation are not fully elucidated.
Does mitral annular displacement predict left ventricular diastolic function improvement at 1 year after TAVI in patients with severe aortic stenosis and LVEF >55%?
Cohort (n=98)
No
Does mitral annular displacement predict left ventricular diastolic function improvement at 1 year after TAVI in patients with severe aortic stenosis and LVEF >55%?
Preserved left ventricular longitudinal function, as measured by mitral annular displacement, predicts diastolic function improvement and favorable clinical outcomes 1 year after TAVI.
Post-TAVI diastolic improvement was associated with lower events and predicted by preserved MAD; hypothesis-generating for MAD-stratified response, needing prospective validation.
BACKGROUND: The clinical significance of left ventricular (LV) diastolic function (DF) improvement after transcatheter aortic valve implantation (TAVI) is not fully elucidated. We sought to investigate the long-term clinical and hemodynamic effects of post-TAVI DF improvement and to identify its determinants. METHODS AND RESULTS: Clinical and serial echocardiographic data before and after TAVI were retrospectively reviewed together with measurement of mitral annular displacement (MAD) representing longitudinal myocardial function in 98 patients with severe aortic stenosis and ejection fraction >55%. DF grade was determined as 0-III according to the current guideline. Patients with ≥1-grade improvement in DF at 1 year (n=59, 60%) showed a better recovery of New York Heart Association functional class, plasma B-type natriuretic peptide level, stroke volume index, and averaged e', and a greater decrease in systolic pulmonary artery pressure than those without DF improvement (all P<0.05). Coronary artery disease (odds ratio (OR), 0.30; 95% confidence interval (CI), 0.11-0.84; P=0.022) and averaged MAD (per 2.5 mm increase; OR, 4.11; 95% CI, 2.18-7.72; P<0.001) were predictors of post-TAVI DF improvement. An averaged MAD cutoff value of 10.7 mm discriminated cases of improvement with a sensitivity of 88% and specificity of 64%. CONCLUSIONS: Post-TAVI DF improvement may be associated with preserved LV longitudinal function and when present may be accompanied by more favorable clinical and hemodynamic changes.
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Utsunomiya et al. (2017) conducted a cohort in Severe symptomatic aortic stenosis with preserved LVEF (n=98). Post-TAVI diastolic function improvement vs. No post-TAVI diastolic function improvement was evaluated on All-cause death or heart failure hospitalization (HR 0.10, 95% CI 0.03-0.29, p=<0.001). Post-TAVI diastolic function improvement was associated with a significantly decreased risk of all-cause death or heart failure hospitalization (HR 0.10) and was predicted by preserved MAD.
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