Diastolic Function and Transcatheter Aortic Valve Replacement

John E.A. Blair, Prashant Atri, Julie L. Friedman, James David Thomas, Kent Brummel, Ranya Nabil Sweis, Issam A Mikati, S Chris Malaisrie, Charles J Davidson, James D Flaherty*

*Corresponding author for this work

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Little is known about baseline diastolic dysfunction and changes in diastolic dysfunction grade after transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) and its impact on overall outcomes. The aim of this study was to describe baseline diastolic dysfunction and changes in diastolic dysfunction grade that occur with TAVR and their relationship to mortality and rehospitalization. Methods This was a single-center study evaluating all TAVRs from January 2012 to June 2014. We compared parameters of diastolic dysfunction grade on pre-TAVR and 1 month post-TAVR echocardiograms for all patients undergoing the procedure. Descriptive statistics, Kaplan-Meier time-to-event analysis, and multivariate logistic regression were used. Results Of a sample size of 120 patients undergoing TAVR for symptomatic severe AS, 90 were included in the final analysis after excluding significant mitral valve disease. There were improvements in individual parameters of diastolic dysfunction grade such as lateral e′ velocity, E/lateral e′, and left atrial volume index (nonsignificant trend) in the setting of improvement in aortic valve area and gradients and functional class pre- and post-TAVR. Multivariate analysis revealed that baseline diastolic dysfunction grade, but not post-TAVR or changes in diastolic dysfunction grade, was associated with 1-year death (hazard ratio, 1.163; 95% CI, 1.049–1.277, P =.005) and combined death/cardiovascular hospitalization (hazard ratio, 1.174; 95% CI, 1.032–1.318; P =.018). Conclusions In this single-center retrospective study of patients with symptomatic severe AS who underwent TAVR, several diastolic function parameters improved on echocardiography, but baseline diastolic dysfunction grade remained the most important echocardiographic factor associated with adverse 1-year outcomes.

Original languageEnglish (US)
Pages (from-to)541-551
Number of pages11
JournalJournal of the American Society of Echocardiography
Volume30
Issue number6
DOIs
StatePublished - Jun 1 2017

Fingerprint

Aortic Valve Stenosis
Multivariate Analysis
Transcatheter Aortic Valve Replacement
Aortic Valve
Mitral Valve
Sample Size
Echocardiography
Hospitalization
Retrospective Studies
Logistic Models
Mortality

Keywords

  • Aortic stenosis
  • Diastolic dysfunction
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{8aec4e9ba1a24ffeb0dd48e6b5860138,
title = "Diastolic Function and Transcatheter Aortic Valve Replacement",
abstract = "Background Little is known about baseline diastolic dysfunction and changes in diastolic dysfunction grade after transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) and its impact on overall outcomes. The aim of this study was to describe baseline diastolic dysfunction and changes in diastolic dysfunction grade that occur with TAVR and their relationship to mortality and rehospitalization. Methods This was a single-center study evaluating all TAVRs from January 2012 to June 2014. We compared parameters of diastolic dysfunction grade on pre-TAVR and 1 month post-TAVR echocardiograms for all patients undergoing the procedure. Descriptive statistics, Kaplan-Meier time-to-event analysis, and multivariate logistic regression were used. Results Of a sample size of 120 patients undergoing TAVR for symptomatic severe AS, 90 were included in the final analysis after excluding significant mitral valve disease. There were improvements in individual parameters of diastolic dysfunction grade such as lateral e′ velocity, E/lateral e′, and left atrial volume index (nonsignificant trend) in the setting of improvement in aortic valve area and gradients and functional class pre- and post-TAVR. Multivariate analysis revealed that baseline diastolic dysfunction grade, but not post-TAVR or changes in diastolic dysfunction grade, was associated with 1-year death (hazard ratio, 1.163; 95{\%} CI, 1.049–1.277, P =.005) and combined death/cardiovascular hospitalization (hazard ratio, 1.174; 95{\%} CI, 1.032–1.318; P =.018). Conclusions In this single-center retrospective study of patients with symptomatic severe AS who underwent TAVR, several diastolic function parameters improved on echocardiography, but baseline diastolic dysfunction grade remained the most important echocardiographic factor associated with adverse 1-year outcomes.",
keywords = "Aortic stenosis, Diastolic dysfunction, Transcatheter aortic valve replacement",
author = "Blair, {John E.A.} and Prashant Atri and Friedman, {Julie L.} and Thomas, {James David} and Kent Brummel and Sweis, {Ranya Nabil} and Mikati, {Issam A} and Malaisrie, {S Chris} and Davidson, {Charles J} and Flaherty, {James D}",
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Diastolic Function and Transcatheter Aortic Valve Replacement. / Blair, John E.A.; Atri, Prashant; Friedman, Julie L.; Thomas, James David; Brummel, Kent; Sweis, Ranya Nabil; Mikati, Issam A; Malaisrie, S Chris; Davidson, Charles J; Flaherty, James D.

In: Journal of the American Society of Echocardiography, Vol. 30, No. 6, 01.06.2017, p. 541-551.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Diastolic Function and Transcatheter Aortic Valve Replacement

AU - Blair, John E.A.

AU - Atri, Prashant

AU - Friedman, Julie L.

AU - Thomas, James David

AU - Brummel, Kent

AU - Sweis, Ranya Nabil

AU - Mikati, Issam A

AU - Malaisrie, S Chris

AU - Davidson, Charles J

AU - Flaherty, James D

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background Little is known about baseline diastolic dysfunction and changes in diastolic dysfunction grade after transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) and its impact on overall outcomes. The aim of this study was to describe baseline diastolic dysfunction and changes in diastolic dysfunction grade that occur with TAVR and their relationship to mortality and rehospitalization. Methods This was a single-center study evaluating all TAVRs from January 2012 to June 2014. We compared parameters of diastolic dysfunction grade on pre-TAVR and 1 month post-TAVR echocardiograms for all patients undergoing the procedure. Descriptive statistics, Kaplan-Meier time-to-event analysis, and multivariate logistic regression were used. Results Of a sample size of 120 patients undergoing TAVR for symptomatic severe AS, 90 were included in the final analysis after excluding significant mitral valve disease. There were improvements in individual parameters of diastolic dysfunction grade such as lateral e′ velocity, E/lateral e′, and left atrial volume index (nonsignificant trend) in the setting of improvement in aortic valve area and gradients and functional class pre- and post-TAVR. Multivariate analysis revealed that baseline diastolic dysfunction grade, but not post-TAVR or changes in diastolic dysfunction grade, was associated with 1-year death (hazard ratio, 1.163; 95% CI, 1.049–1.277, P =.005) and combined death/cardiovascular hospitalization (hazard ratio, 1.174; 95% CI, 1.032–1.318; P =.018). Conclusions In this single-center retrospective study of patients with symptomatic severe AS who underwent TAVR, several diastolic function parameters improved on echocardiography, but baseline diastolic dysfunction grade remained the most important echocardiographic factor associated with adverse 1-year outcomes.

AB - Background Little is known about baseline diastolic dysfunction and changes in diastolic dysfunction grade after transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) and its impact on overall outcomes. The aim of this study was to describe baseline diastolic dysfunction and changes in diastolic dysfunction grade that occur with TAVR and their relationship to mortality and rehospitalization. Methods This was a single-center study evaluating all TAVRs from January 2012 to June 2014. We compared parameters of diastolic dysfunction grade on pre-TAVR and 1 month post-TAVR echocardiograms for all patients undergoing the procedure. Descriptive statistics, Kaplan-Meier time-to-event analysis, and multivariate logistic regression were used. Results Of a sample size of 120 patients undergoing TAVR for symptomatic severe AS, 90 were included in the final analysis after excluding significant mitral valve disease. There were improvements in individual parameters of diastolic dysfunction grade such as lateral e′ velocity, E/lateral e′, and left atrial volume index (nonsignificant trend) in the setting of improvement in aortic valve area and gradients and functional class pre- and post-TAVR. Multivariate analysis revealed that baseline diastolic dysfunction grade, but not post-TAVR or changes in diastolic dysfunction grade, was associated with 1-year death (hazard ratio, 1.163; 95% CI, 1.049–1.277, P =.005) and combined death/cardiovascular hospitalization (hazard ratio, 1.174; 95% CI, 1.032–1.318; P =.018). Conclusions In this single-center retrospective study of patients with symptomatic severe AS who underwent TAVR, several diastolic function parameters improved on echocardiography, but baseline diastolic dysfunction grade remained the most important echocardiographic factor associated with adverse 1-year outcomes.

KW - Aortic stenosis

KW - Diastolic dysfunction

KW - Transcatheter aortic valve replacement

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