Does the presence of a restrictive left-ventricular diastolic filling pattern and dilated left atrium predict mortality and heart failure hospitalization in patients with aortic stenosis and LVEF < 40% undergoing aortic valve replacement?
Restrictive left-ventricular diastolic filling pattern and dilated left atrium are independent predictors of mortality in patients with aortic stenosis and severe LV systolic dysfunction undergoing aortic valve replacement.
Background and Objectives: Patients with surgical aortic stenosis (AS) show impaired diastolic filling, which is a risk factor for early and late mortality after aortic valve replacement (AVR). There is a paucity of information concerning the impact of restrictive diastolic filling and the evolution of diastolic dysfunction in the early and medium terms post-AVR. We aimed to determine the prognostic value of the presence of a restrictive left-ventricular (LV) diastolic filling pattern (LVDFP) and dilated left atrium (LA) in patients with AS and LV systolic dysfunction (LVEF 55 mm and the presence of second-degree mitral regurgitation. Restrictive LVDFP and LA dimension >30 mm/m2 were independent predictors for fatal outcome (p = 0.0017). Conclusions: Assessment of diastolic function and LA dimension are reliable parameters in predicting fatal outcome and hospitalization for heart failure, having an independent and incremental prognostic value in patients with surgical AS. Complete evaluation of LVDFP with all the echographic measurements (including TDI) should routinely be part of the preoperative assessment of patients with LV systolic dysfunction undergoing AVR.
Iliuță et al. (Fri,) studied this question.