August 23, 2011European Journal of Echocardiography60 citations

Acute left ventricle diastolic function improvement after transcatheter aortic valve implantation

AGAlexandra Gonçalves PMPedro Marcos‐Alberca CACarlos Almerı́a

Structured PICO

Does TAVI improve acute LV diastolic function in patients with severe aortic stenosis and preserved LV systolic function?

Population

61 patients with severe aortic valve stenosis and preserved LV systolic function, all with baseline LV diastolic dysfunction, mean age 83.5±6 years, mean log EuroSCORE 18.2±9.4.

Intervention

Transcatheter aortic valve implantation (TAVI)

Comparator

Baseline (pre-procedure parameters)

Outcome

Acute haemodynamic effects in left ventricle (LV) diastolic performance evaluated minutes after TAVIsurrogate

TAVI provides immediate improvement in echocardiographic and invasive parameters of LV diastolic function in patients with severe aortic stenosis and preserved systolic function.

Abstract

AIMS: Data regarding the effects of TAVI on LV after are scarce and conflicting results have been reported immediately after aortic valvuloplasty. This study aimed to determine the acute haemodynamic effects of transcatheter aortic valve implantation (TAVI) in left ventricle (LV) diastolic performance, immediately after aortic valvuloplasty and prosthesis deployment. METHODS AND RESULTS: Sixty-one patients with severe aortic valve stenosis, and preserved LV systolic function submitted to successful TAVI, were included. All procedures were guided through transoesophageal echocardiography, and parameters of diastolic function were evaluated before and minutes after TAVI. The mean age was 83.5±6 years and mean log EuroSCORE was 18.2±9.4. Before the procedure, all patients presented LV diastolic dysfunction. Immediately after TAVI, fewer patients presented a restrictive pattern 27 (44.3%), before the procedure, vs. 20 (34.4%), after TAVI (P=0.047), and an increase in E wave deceleration time (211.2±75.5 vs. 252.7±102.3 cm/s, P=0.001), in E wave velocity (109.5±41.2 vs. 120.3±43.6 cm/s, P=0.025), and in isovolumetric relaxation time (83±36.5 vs. 97.1±36.0 ms, P=0.013) was observed. On multivariate analysis of covariance (ANCOVA), adjusting to LV systolic function, heart rate, blood pressure, and haematocrit values, the results remained significant. Patients referred to percutaneous approach had invasive haemodynamic data collected, showing a decrease in LV end-diastolic pressure after valve implantation 18.8±5.7 vs. 14.7±4.7, mean difference -4.1 (95% CI: -5.9; -2.9). Patients with a restrictive pattern immediately after TAVI presented a smaller decrease in LV end diastolic pressure (-3.3±4.7) than those with diastolic dysfunction grade I or II (-9.5±4.7; P=0.017). CONCLUSION: This is the first study describing LV diastolic performance during TAVI. Our results show improvement in diastolic function parameters in patients with preserved LV systolic function, immediately after successful TAVI.

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