Baseline grade 3 diastolic dysfunction predicted 1-year cardiovascular death or rehospitalization (HR 2.73; 95% CI 1.07-6.98; P=0.04) in patients undergoing TAVR.
Cohort (n=1,750)
Yes
Does baseline diastolic dysfunction grade predict cardiovascular death or rehospitalization in patients with aortic stenosis undergoing TAVR?
Baseline severe diastolic dysfunction and lack of early improvement in diastolic function are significant predictors of adverse clinical outcomes following TAVR.
Hazard Ratio: 2.73 (95% CI 1.07–6.98)
p-value: p=0.04
BACKGROUND Few studies have evaluated if diastolic function could predict outcomes in patients with aortic stenosis. OBJECTIVES The authors aimed to assess the association between diastolic dysfunction (DD) and outcomes in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). METHODS Baseline, 30-day, and 1- and 2-year transthoracic echocardiograms from the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registry were analyzed by a consortium of core laboratories and divided into the American Society of Echocardiography DD groups. RESULTS Among the 1,750 included, 682 (54.4%) had grade 1 DD, 352 (28.1%) had grade 2 DD, 168 (13.4%) had grade 3 DD, and 51 (4.1%) had indeterminate DD grade. Incremental baseline grades of DD were associated with an increase in combined 1- and 2-year cardiovascular (CV) death/rehospitalization (all p < 0.002) and all-cause death at 2 years (p = 0.01) but not at 1 year. Improvement in DD grade/grade 1 DD at 30 days post-TAVR was seen in 70.8% patients. Patients with improvement in ≥1 grade of DD/grade 1 DD had reduced 1-year CV death/rehospitalization (p < 0.001) and increased 2-year survival (p = 0.01). Baseline grade 3 DD was a predictor of 1-year CV death/rehospitalization (hazard ratio: 2.73; 95% confidence interval: 1.07 to 6.98; p = 0.04). Improvement in DD grade/grade 1 DD at 30 days was protective for 1-year CV death/rehospitalizations (hazard ratio: 0.39; 95% confidence interval: 0.19 to 0.83; p = 0.01). CONCLUSIONS In the PARTNER 2 SAPIEN 3 registry, baseline DD was a predictor of up to 2 years clinical outcomes in patients who underwent TAVR. Improvement in DD grade at 30 days was associated with improvement in short-term clinical outcomes. (The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - PARTNER II - PARTNERII - S3 Intermediate PARTNERII S3i; NCT03222128; PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - High Risk and Nested Registry 7 PII S3HR/NR7; NCT03222141).
Ong et al. (Tue,) conducted a cohort in Aortic stenosis (n=1,750). Diastolic dysfunction vs. Lower grades of diastolic dysfunction was evaluated on 1-year cardiovascular death or rehospitalization (HR 2.73, 95% CI 1.07-6.98, p=0.04). Baseline grade 3 diastolic dysfunction predicted 1-year cardiovascular death or rehospitalization (HR 2.73; 95% CI 1.07-6.98; P=0.04) in patients undergoing TAVR.