open access

Vol 26, No 1 (2019)
Original articles — Clinical cardiology
Published online: 2018-01-25
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Medium and long-term prognosis of transcatheter aortic valve implantation from the perspective of left ventricular diastolic function

Satoru Kayama, Shungo Aratake, Shegehito Sawamura, Yusuke Watanabe, Ken Kozuma
DOI: 10.5603/CJ.a2018.0005
·
Pubmed: 29570210
·
Cardiol J 2019;26(1):29-35.

open access

Vol 26, No 1 (2019)
Original articles — Clinical cardiology
Published online: 2018-01-25

Abstract

Background: The effects of left ventricular (LV) diastolic function are well known in cardiac surgery, but unclear in transcatheter aortic valve implantation (TAVI). The objective of this study was to exam- ine the association of preoperative LV diastolic function with medium to long-term outcomes of TAVI. Methods: Eighty patients who underwent TAVI were classified into grades I, II and III based on pre- operative LV diastolic function. Findings related to cardiovascular outcomes after TAVI were extracted retrospectively from clinical and echocardiographic data and relationships with diastolic function were examined.
Results: The average follow-up was 529 days (interquartile range {IQR] 358–741 days). Cardiovascu- lar events occurred in 17 cases, including 6 deaths, and were significantly associated with Euro II score (p = 0.043), albumin level (p = 0.026), coronary artery disease (CAD) (p = 0.017), and diastolic func- tion (p < 0.001). The 360-day event-free rates were 89.5%, 89.5% and 37.5% for grades I, II and III (p = 0.00013). Median event-free survival (EFS) in grade III cases was 180 days. In a Cox propor- tional hazard model, LV diastolic dysfunction (hazard ratio [HR] 3.99, 95% confidence interval [CI] 1.35–11.80, p = 0.012) and low albumin (HR 4.73, 95% CI 1.42–15.80, p = 0.012) were significant independent predictors of reduced EFS.
Conclusions: Medium to long-term outcomes of TAVI were poorer in patients with deteriorated LV diastolic function, and outcomes in grade III cases were significantly worse than those in grade I and II cases. Preoperative LV diastolic function may be useful in prediction of outcomes after TAVI. 

Abstract

Background: The effects of left ventricular (LV) diastolic function are well known in cardiac surgery, but unclear in transcatheter aortic valve implantation (TAVI). The objective of this study was to exam- ine the association of preoperative LV diastolic function with medium to long-term outcomes of TAVI. Methods: Eighty patients who underwent TAVI were classified into grades I, II and III based on pre- operative LV diastolic function. Findings related to cardiovascular outcomes after TAVI were extracted retrospectively from clinical and echocardiographic data and relationships with diastolic function were examined.
Results: The average follow-up was 529 days (interquartile range {IQR] 358–741 days). Cardiovascu- lar events occurred in 17 cases, including 6 deaths, and were significantly associated with Euro II score (p = 0.043), albumin level (p = 0.026), coronary artery disease (CAD) (p = 0.017), and diastolic func- tion (p < 0.001). The 360-day event-free rates were 89.5%, 89.5% and 37.5% for grades I, II and III (p = 0.00013). Median event-free survival (EFS) in grade III cases was 180 days. In a Cox propor- tional hazard model, LV diastolic dysfunction (hazard ratio [HR] 3.99, 95% confidence interval [CI] 1.35–11.80, p = 0.012) and low albumin (HR 4.73, 95% CI 1.42–15.80, p = 0.012) were significant independent predictors of reduced EFS.
Conclusions: Medium to long-term outcomes of TAVI were poorer in patients with deteriorated LV diastolic function, and outcomes in grade III cases were significantly worse than those in grade I and II cases. Preoperative LV diastolic function may be useful in prediction of outcomes after TAVI. 

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Keywords

left ventricular diastolic function; aortic stenosis; transcatheter aortic valve implantation (TAVI); outcomes; prognosis; echocardiography

About this article
Title

Medium and long-term prognosis of transcatheter aortic valve implantation from the perspective of left ventricular diastolic function

Journal

Cardiology Journal

Issue

Vol 26, No 1 (2019)

Pages

29-35

Published online

2018-01-25

DOI

10.5603/CJ.a2018.0005

Pubmed

29570210

Bibliographic record

Cardiol J 2019;26(1):29-35.

Keywords

left ventricular diastolic function
aortic stenosis
transcatheter aortic valve implantation (TAVI)
outcomes
prognosis
echocardiography

Authors

Satoru Kayama
Shungo Aratake
Shegehito Sawamura
Yusuke Watanabe
Ken Kozuma

References (22)
  1. Costantino MF, Galderisi M, Dores E, et al. Parallel improvement of left ventricular geometry and filling pressure after transcatheter aortic valve implantation in high risk aortic stenosis: comparison with major prosthetic surgery by standard echo Doppler evaluation. Cardiovasc Ultrasound. 2013; 11: 18.
  2. Van Mieghem NM, Chieffo A, Dumonteil N, et al. Trends in outcome after transfemoral transcatheter aortic valve implantation. Am Heart J. 2013; 165(2): 183–192.
  3. Lichtenstein SV, Cheung A, Ye J, et al. Transapical transcatheter aortic valve implantation in humans: initial clinical experience. Circulation. 2006; 114(6): 591–596.
  4. Sarı C, Aslan AN, Baştuğ S, et al. Immediate recovery of the left atrial and left ventricular diastolic function after transcatheter aortic valve implantation: A transesophageal echocardiography study. Cardiol J. 2016; 23(4): 449–455.
  5. Rosato S, Santini F, Barbanti M, et al. OBSERVANT Research Group. Transcatheter Aortic Valve Implantation Compared With Surgical Aortic Valve Replacement in Low-Risk Patients. Circ Cardiovasc Interv. 2016; 9(5): e003326.
  6. Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363(17): 1597–1607.
  7. Yamamoto M, Shimura T, Kano S, et al. Prognostic Value of Hypoalbuminemia After Transcatheter Aortic Valve Implantation (from the Japanese Multicenter OCEAN-TAVI Registry). Am J Cardiol. 2017; 119(5): 770–777.
  8. Zhao Y, Lindqvist P, Nilsson J, et al. Trans-catheter aortic valve implantation--early recovery of left and preservation of right ventricular function. Interact Cardiovasc Thorac Surg. 2011; 12(1): 35–39.
  9. Lancellotti P, Magne J, Donal E, et al. Clinical outcome in asymptomatic severe aortic stenosis: insights from the new proposed aortic stenosis grading classification. J Am Coll Cardiol. 2012; 59(3): 235–243.
  10. Holme I, Pedersen TR, Boman K, et al. A risk score for predicting mortality in patients with asymptomatic mild to moderate aortic stenosis. Heart. 2012; 98(5): 377–383.
  11. Gonçalves A, Marcos-Alberca P, Almeria C, et al. Acute left ventricle diastolic function improvement after transcatheter aortic valve implantation. Eur J Echocardiogr. 2011; 12(10): 790–797.
  12. Clavel MA, Webb JG, Rodés-Cabau J, et al. Comparison between transcatheter and surgical prosthetic valve implantation in patients with severe aortic stenosis and reduced left ventricular ejection fraction. Circulation. 2010; 122(19): 1928–1936.
  13. Vizzardi E, D'Aloia A, Fiorina C, et al. Early regression of left ventricular mass associated with diastolic improvement after transcatheter aortic valve implantation. J Am Soc Echocardiogr. 2012; 25(10): 1091–1098.
  14. Zamorano JL, Badano LP, Bruce C, et al. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease. J Am Soc Echocardiogr. 2011; 24(9): 937–965.
  15. Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013; 26(9): 921–964.
  16. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendation for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016; 17(12): 1321–1360.
  17. Kaw R, Hernandez AV, Pasupuleti V, et al. Effect of diastolic dysfunction on postoperative outcomes after cardiovascular surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg. 2016; 152(4): 1142–1153.
  18. La Manna A, Sanfilippo A, Capodanno D, et al. Left ventricular reverse remodeling after transcatheter aortic valve implantation: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2013; 15: 39.
  19. van Straten AHM, Soliman Hamad MA, Peels KCH, et al. Increased septum wall thickness in patients undergoing aortic valve replacement predicts worse late survival. Ann Thorac Surg. 2012; 94(1): 66–71.
  20. Gibbs J, Cull W, Henderson W, et al. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg. 1999; 134(1): 36–42.
  21. Sündermann S, Dademasch A, Rastan A, et al. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery. Eur J Cardiothorac Surg. 2011; 39(1): 33–37.
  22. Basraon J, Chandrashekhar YS, John R, et al. Comparison of risk scores to estimate perioperative mortality in aortic valve replacement surgery. Ann Thorac Surg. 2011; 92(2): 535–540.

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