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van Wely M, Rooijakkers M, Stens N, El Messaoudi S, Somers T, van Garsse L, Thijssen D, Nijveldt R, van Royen N. Paravalvular regurgitation after transcatheter aortic valve replacement: incidence, quantification, and prognostic impact. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2024; 2:qyae040. [PMID: 39045465 PMCID: PMC11195773 DOI: 10.1093/ehjimp/qyae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/21/2024] [Indexed: 07/25/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) is the standard of care in aortic stenosis with results comparable to surgical aortic valve replacement. However, paravalvular regurgitation (PVR) is more common after TAVR. With the alteration of devices and implantation techniques, the incidence of moderate or more PVR has declined. Mild PVR is still common in around 30% of TAVR patients in low-risk trials. Progression of AS causes myocardial hypertrophy and varying degrees of diastolic dysfunction which may cause heart failure even in combination with small volumes of PVR. Any degree of PVR is associated with an increased risk of overall and cardiovascular mortality. Predictors of PVR are annular eccentricity, severe calcification of the aortic valve, bicuspid aortic valves, and type of prosthesis where balloon-expandable devices are associated with less PVR. PVR is diagnosed using echocardiography, aortic angiogram with or without videodensitometry, haemodynamic parameters, or cardiac magnetic resonance. PVR can be treated using post-dilation, interventional treatment using a vascular plug, or implantation of a second device. Successful post-dilation depends on balloon size which should at least be equal to or >95% of the mean annulus diameter. Implantation of a second device to reduce PVR is successful in ∼90% of cases, either through lengthening of the sealing skirt in case of inadequate position or through further expansion of the index device. Implantation of a vascular plug can successfully reduce PVR and reduce mortality.
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Affiliation(s)
- Marleen van Wely
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Maxim Rooijakkers
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Niels Stens
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Department of Physiology, Radboudumc , Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Saloua El Messaoudi
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Tim Somers
- Department of Cardiothoracic Surgery, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Leen van Garsse
- Department of Cardiothoracic Surgery, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Dick Thijssen
- Department of Physiology, Radboudumc , Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboudumc, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Angellotti D, Manzo R, Castiello DS, Immobile Molaro M, Mariani A, Iapicca C, Nappa D, Simonetti F, Avvedimento M, Leone A, Canonico ME, Spaccarotella CAM, Franzone A, Ilardi F, Esposito G, Piccolo R. Echocardiographic Evaluation after Transcatheter Aortic Valve Implantation: A Comprehensive Review. Life (Basel) 2023; 13:1079. [PMID: 37240724 PMCID: PMC10221682 DOI: 10.3390/life13051079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an increasingly popular treatment option for patients with severe aortic stenosis. Recent advancements in technology and imaging tools have significantly contributed to the success of TAVI procedures. Echocardiography plays a pivotal role in the evaluation of TAVI patients, both before and after the procedure. This review aims to provide an overview of the most recent technical advancements in echocardiography and their use in the follow-up of TAVI patients. In particular, the focus will be on the examination of the influence of TAVI on left and right ventricular function, which is frequently accompanied by other structural and functional alterations. Echocardiography has proven to be key also in detecting valve deterioration during extended follow-up. This review will provide valuable insights into the technical advancements in echocardiography and their role in the follow-up of TAVI patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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3
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AlHarbi H, AlAhmari M, Alanazi AM, Al-Ghamdi B, AlSuayri A, AlHaydhal A, Arafat AA, Algarni KD, Abdelsalam W, AlRajwi S, AlMoghairi A, AlAmri H, AlAhmari S, AlOtaiby M. Outcomes After Transcatheter Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Diastolic Dysfunction. J Saudi Heart Assoc 2021; 33:26-34. [PMID: 33936938 PMCID: PMC8084307 DOI: 10.37616/2212-5043.1236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/23/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Left ventricular diastolic dysfunction (LVDD) in patients undergoing transcatheter aortic valve replacement (TAVR) is associated with poor outcomes; however, the effect of its severity is controversial. We sought to assess the impact of diastolic dysfunction on hospital outcomes and survival after TAVR and identify prognostic factors. METHODS We included patients who underwent TAVR for severe aortic stenosis with preexisting LVDD from 2009 to 2018 (n = 325). Patients with prior mitral valve surgery (n = 4), atrial fibrillation (n = 39), missing or poor baseline diastolic dysfunction assessment (n = 36) were excluded. The primary endpoint was all-cause mortality. 246 patients were included in the study. RESULTS The median age was 80 years (25th and 75th percentiles:75-86.7), 154 (62.6%) were males and the median EuroSCORE II was 4.3 (2.2-8). Patients with severe LVDD had significantly higher EuroSCORE, and lower ejection fraction (p < 0.001). There was no difference in post-TAVR new atrial fibrillation (p = 0.912), pacemaker insertion (p = 0.528), stroke (p = 0.76), or hospital mortality (p = 0.95). Patients with severe LVDD had longer hospital stay (p = 0.036). The grade of LVDD did not affect survival (log-rank = 0.145) nor major adverse cardiovascular events (log-rank = 0.97). Predictors of mortality were; low BMI (HR: 0.95 (0.91-0.99); p = 0.019), low sodium (0.93 (0.82-2.5); p = 0.021), previous PCI (HR: 1.6 (1.022-2.66); p = 0.04), E-peak (HR: 1.01 (1.002-1.019); p = 0.014) and implantation of more than one device (HR: 3.55 (1.22-10.31); p = 0.02). CONCLUSION Transcatheter aortic valve replacement is feasible in patients with diastolic dysfunction, and the degree of diastolic dysfunction did not negatively affect the outcome. Long-term outcomes in those patients were affected by the preoperative clinical state and procedure-related factors.
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Affiliation(s)
- Hassan AlHarbi
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Mohammed AlAhmari
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | | | - Bander Al-Ghamdi
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Abdullah AlSuayri
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Ahmed AlHaydhal
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Amr A. Arafat
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Khaled D. Algarni
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Wiam Abdelsalam
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Sameera AlRajwi
- Adult Cardiology Department, King Abdulaziz Cardiac Centre, Ministry of National Guard Riyadh,
Saudi Arabia
| | | | - Hussin AlAmri
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Saeed AlAhmari
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Mohammed AlOtaiby
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
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4
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Aortic Stenosis and Diastolic Dysfunction: Partners in Crime. J Am Coll Cardiol 2021; 76:2952-2955. [PMID: 33334423 DOI: 10.1016/j.jacc.2020.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 01/28/2023]
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5
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Tarantini G, Nai Fovino L. Preexisting diastolic dysfunction in patients undergoing TAVR matters-But what about diastole the day after TAVR? Catheter Cardiovasc Interv 2020; 95:1338-1339. [PMID: 32537865 DOI: 10.1002/ccd.29049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/16/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
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Takagi H, Hari Y, Nakashima K, Yokoyama Y, Ueyama H, Kuno T, Ando T. Baseline left ventricular diastolic dysfunction affects midterm mortality after transcatheter aortic valve implantation. J Card Surg 2019; 35:536-543. [PMID: 31886935 DOI: 10.1111/jocs.14409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine whether preprocedural left ventricular (LV) diastolic dysfunction impairs midterm mortality after transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS), we performed a meta-analysis of currently available evidence. METHODS We identified all studies investigating impact of preprocedural severity of LV diastolic dysfunction on midterm (≥1-year) all-cause mortality after TAVI for patients with AS through a search of databases (MEDLINE and EMBASE) until September 2019. From each study, we extracted an adjusted (if unavailable, unadjusted) hazard ratio (HR) of midterm mortality. We pooled study-specific estimates in the random-effects model. RESULTS Ten eligible studies with a total of 2380 patients with AS undergoing TAVI were identified. In accordance with pooled analyses, higher-grade preprocedural LV diastolic dysfunction was associated with significantly worse midterm all-cause mortality after TAVI compared to lower-grade dysfunction (HR for grade II vs I, 1.15; P = .002; HR for grade III vs I, 1.35; P = .001; HR for grade III vs II; 1.16, P = .002; HR for grade II-III vs I, II-III vs 0-I, or III vs I-II, 1.34; P < .00001 [primary meta-analysis]; HR per grade, 1.16; P = .003). No funnel plot asymmetry for the primary meta-analysis (for grade II-III vs I, II-III vs 0-I, or III vs I-II) was identified, which probably indicated no publication bias (P = .381 by the linear-regression test). CONCLUSION Higher-grade preprocedural LV diastolic dysfunction was associated with worse midterm all-cause mortality after TAVI for patients with AS compared to lower-grade dysfunction.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kouki Nakashima
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yujiro Yokoyama
- Department of Surgery, Easton Hospital, Easton, Pennsylvania
| | - Hiroki Ueyama
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Tomo Ando
- Division of Interventional Cardiology, Department of Cardiology, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
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7
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Malik AO, Omer M, Pflederer MC, Almomani A, Gosch KL, Jones PG, Peri-Okonny PA, Al Badarin F, Brandt HA, Arnold SV, Main ML, Cohen DJ, Spertus JA, Chhatriwalla AK. Association Between Diastolic Dysfunction and Health Status Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:2476-2484. [PMID: 31786216 DOI: 10.1016/j.jcin.2019.08.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to assess the association of baseline left ventricular diastolic dysfunction (LVDD) with health status outcomes of patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND Although LVDD in patients with aortic stenosis is associated with higher mortality after TAVR, it is unknown if it is also associated with health status recovery. METHODS In a cohort of 304 patients with interpretable echocardiograms, undergoing TAVR, LVDD was categorized at baseline as absent (grade 0), mild (grade 1), moderate (grade 2), or severe (grade 3). Disease-specific health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) at baseline and at 1-month and 12-month follow-up. Association of baseline LVDD with health status at baseline and follow-up after TAVR was assessed using a linear trend test, and association with health status recovery (change in KCCQ-OS) was examined using a linear mixed model adjusting for baseline KCCQ-OS. RESULTS Twenty-four (7.9%), 54 (17.8%), 186 (61.2%), and 40 (13.2%) patients had LVDD grades of 0, 1, 2, and 3, respectively. Baseline KCCQ-OS was 61.3 ± 22.7, 51.0 ± 26.1, 44.7 ± 25.7, and 44.4 ± 21.9 (p = 0.004) in patients with LVDD grades of 0, 1,2 and 3. At 1 and 12 months after TAVR, LVDD was not associated with KCCQ-OS. Recovery in KCCQ-OS after TAVR was substantial and similar in patients across all severities of LVDD. CONCLUSIONS Although LVDD is associated with health status prior to TAVR, patients across all severities of LVDD have similar recovery in health status after TAVR.
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Affiliation(s)
- Ali O Malik
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
| | - Mohamed Omer
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Mathew C Pflederer
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Ahmed Almomani
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Poghni A Peri-Okonny
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Firas Al Badarin
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Hunter A Brandt
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Suzanne V Arnold
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Michael L Main
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - David J Cohen
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - John A Spertus
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Adnan K Chhatriwalla
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
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8
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Kampaktsis PN, Vavuranakis M, Choi DY, Sherifi I, Christofi A, Triantafyllou D, Siasos G, Salemi A, Tousoulis D, Wong SC, Devereux RB. Prognostic role of diastolic dysfunction in patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 95:1024-1031. [DOI: 10.1002/ccd.28426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/25/2019] [Indexed: 02/02/2023]
Affiliation(s)
| | - Manolis Vavuranakis
- 1st Cardiology ClinicHippokrateion Hospital/University of Athens Medical School Athens Greece
| | - Daniel Y. Choi
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Ines Sherifi
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Angela Christofi
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Dionysis Triantafyllou
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Gerasimos Siasos
- 1st Cardiology ClinicHippokrateion Hospital/University of Athens Medical School Athens Greece
| | - Arash Salemi
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Dimitrios Tousoulis
- 1st Cardiology ClinicHippokrateion Hospital/University of Athens Medical School Athens Greece
| | - S. Chiu Wong
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Richard B. Devereux
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
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Aalaei-Andabili SH, Bavry AA. Left Ventricular Diastolic Dysfunction and Transcatheter Aortic Valve Replacement Outcomes: A Review. Cardiol Ther 2019; 8:21-28. [PMID: 30847743 PMCID: PMC6525224 DOI: 10.1007/s40119-019-0134-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Indexed: 12/23/2022] Open
Abstract
Aortic stenosis (AS) is the most common valvular disease that can lead to increased afterload, left ventricular (LV) remodeling, and myocardial fibrosis. We reviewed the literature addressing the impact of transcatheter aortic valve replacement (TAVR) on LV remodeling and patients' outcomes by elimination of AS-related high afterload. TAVR reduces afterload and improves LV remodeling recovery. However, myocardial fibrosis may not completely reverse after the TAVR. The LV diastolic dysfunction (LVDD) induced by AS is an independent predictor of post-TAVR mortality, and mortality increases with severity of LVDD. The impact of diastolic dysfunction on patient outcomes emerges at 30 days but continues to persist during mid-term follow-up. Based on severity of the baseline LVDD, some patients may tolerate post-TAVR aortic regurgitation (AR), but even minimal post-TAVR AR in patients with severe baseline LVDD can have an additive negative impact on survival. It is crucial to consider TAVR prior to development of advanced LVDD. Appropriate device selection and deployment technique are important in improvement of TAVR outcomes via elimination of AR.
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Affiliation(s)
| | - Anthony A Bavry
- Department of Medicine, University of Florida, Gainesville, FL, USA.
- North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.
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10
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Sato K, Harb S, Kumar A, Kapadia SR, Mick S, Krishnaswamy A, Desai MY, Griffin BP, Rodriguez LL, Tuzcu EM, Svensson LG, Popović ZB. Impact of left ventricular diastolic function and survival in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. PLoS One 2018; 13:e0196031. [PMID: 29718948 PMCID: PMC5931627 DOI: 10.1371/journal.pone.0196031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/05/2018] [Indexed: 11/18/2022] Open
Abstract
In year 2016, the American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) updated Recommendations for the assessment and grading of diastolic dysfunction (DD). We aimed to assess the applicability of this DD grading method and its association with prognosis in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI). We retrospectively identified 237 consecutive patients with severe AS who underwent trans-femoral TAVI. Baseline transthoracic echocardiography was evaluated to assess pre- and post-TAVI diastolic function according to the current ASE/EACVI Recommendations. Prior to TAVI, 41 (17%) patients were diagnosed as having grade I DD, 111 (47%) patients had grade II DD, 80 (34%) had grade III DD. DD grade after TAVI decreased (p < 0.001) with 75 patients (32%) reclassified to a lower DD grade. During the median follow-up of 1,320 days, 136 (57%) patients died. In univariable Cox proportional hazards model analysis, neither pre- nor post-TAVI DD grade were associated with prognosis. However, patients with grade III DD detected before TAVI and AR≥ 2 after TAVI had poorer survival (p<0.008). Patients with grade III DD detected after TAVI and AR≥ 2 after TAVI had poorer prognosis (p = 0.002). TAVI improves DD grade. While poor DD grade was not associated with mortality after treatment of AS by TAVI, concomitant presence of DD and post-procedural AR carried a poor prognosis.
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Affiliation(s)
- Kimi Sato
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Serge Harb
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Arnav Kumar
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Samir R. Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Stephanie Mick
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Milind Y. Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Brian P. Griffin
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - L. Leonardo Rodriguez
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - E. Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Lars G. Svensson
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Zoran B. Popović
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
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11
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Asami M, Lanz J, Stortecky S, Räber L, Franzone A, Heg D, Hunziker L, Roost E, Siontis GCM, Valgimigli M, Windecker S, Pilgrim T. The Impact of Left Ventricular Diastolic Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:593-601. [DOI: 10.1016/j.jcin.2018.01.240] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/11/2017] [Accepted: 01/01/2018] [Indexed: 12/17/2022]
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12
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Pellikka PA, Padang R. Diastolic Dysfunction Pre-Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:602-604. [DOI: 10.1016/j.jcin.2018.01.267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/30/2018] [Indexed: 01/05/2023]
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13
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A Novel Angiographic Quantification of Aortic Regurgitation After TAVR Provides an Accurate Estimation of Regurgitation Fraction Derived From Cardiac Magnetic Resonance Imaging. JACC Cardiovasc Interv 2018; 11:287-297. [DOI: 10.1016/j.jcin.2017.08.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/24/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022]
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14
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Kwong RY, Kramer CM, Chandrashekhar Y. ECV for Patients With Aortic Stenosis. JACC Cardiovasc Imaging 2017; 10:1408-1409. [DOI: 10.1016/j.jcmg.2017.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Kampaktsis PN, Kokkinidis DG, Wong SC, Vavuranakis M, Skubas NJ, Devereux RB. The role and clinical implications of diastolic dysfunction in aortic stenosis. Heart 2017; 103:1481-1487. [PMID: 28684437 DOI: 10.1136/heartjnl-2017-311506] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 04/19/2017] [Indexed: 12/19/2022] Open
Abstract
Diastolic dysfunction in aortic stenosis results primarily from left ventricular hypertrophy and myocardial fibrosis due to chronically elevated left ventricular systolic pressure. Currently, diastolic dysfunction does not have an explicit clinical role in management of patients with aortic stenosis. Studies have shown that improvement in diastolic dysfunction follows left ventricular remodelling after aortic valve replacement and that it occurs gradually or incompletely. Retrospective studies suggest that advanced grades of diastolic dysfunction at baseline are associated with increased mortality and adverse events even after aortic valve replacement. Recent studies have also associated myocardial fibrosis, a hallmark of diastolic dysfunction, with worse outcomes. In addition, these results were independent of the degree of aortic stenosis or valve replacement. Indirect evidence of the role of diastolic dysfunction in aortic stenosis also comes from paradoxical low-flow, low-gradient aortic stenosis, where disproportionate left ventricular hypertrophy leads to underfilling of the left ventricle, low-flow state and is associated with worse prognosis. Lastly, a limited number of studies suggest that worse diastolic dysfunction at baseline is detrimental in patients who develop aortic regurgitation after transcatheteraortic valve replacement, due to superimposition of volume overload on a stiff left ventricle. Current major limitations in our understanding of the prognostic role of diastolic dysfunction are the lack of universally accepted classification schemes, its dependence on dynamic loading conditions and the lack of larger prospective studies.
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Affiliation(s)
- Polydoros N Kampaktsis
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA.,Society of Junior Doctors, Athens, Greece
| | - Damianos G Kokkinidis
- Society of Junior Doctors, Athens, Greece.,Division of Cardiology, Denver VA Medical Center and University of Colorado, Denver, Colorado, USA
| | - Shing-Chiu Wong
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
| | - Manolis Vavuranakis
- National Kapodistrian University of Athens, 1st Cardiology Clinic, Athens, Greece
| | - Nikolaos J Skubas
- Department of Anesthesiology, New York Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Richard B Devereux
- Department of Medicine, Division of Cardiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York, USA
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