Author + information
- Received October 4, 2017
- Revision received December 11, 2017
- Accepted January 1, 2018
- Published online March 19, 2018.
- Masahiko Asami, MDa,
- Jonas Lanz, MDa,
- Stefan Stortecky, MDa,
- Lorenz Räber, MD, PhDa,
- Anna Franzone, MDa,
- Dik Heg, PhDb,
- Lukas Hunziker, MDa,
- Eva Roost, MDc,
- George CM Siontis, MD, PhDa,
- Marco Valgimigli, MD, PhDa,
- Stephan Windecker, MDa and
- Thomas Pilgrim, MDa,∗ ()
- aDepartment of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
- bInstitute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
- cDepartment of Cardiac Surgery, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
- ↵∗Address for correspondence:
Dr. Thomas Pilgrim, Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, CH-3010 Bern, Switzerland.
Objectives This study sought to determine the impact of left ventricular diastolic dysfunction (LVDD) on clinical outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).
Background Left ventricular (LV) hypertrophy in response to afterload increase promotes the development of LVDD and represents an early stage in the progression to valvular heart failure.
Methods In a consecutive cohort of 777 aortic stenosis patients undergoing TAVR, LVDD was categorized according to the latest guidelines. The primary endpoint was 1-year all-cause mortality.
Results There were 545 (70.1%) patients with LVDD. Ninety-eight (18.0%), 198 (36.3%), and 104 (19.1%) patients were classified as LVDD grades I, II, and III, respectively. In 145 (26.6%) patients, LVDD grade could not be determined because of only 1 or 2 discrepant variables. One-year all-cause mortality was higher in patients with LVDD grades I (16.3%; adjusted hazard ratio [HR]adj: 2.32; 95% confidence interval [CI]: 1.15 to 4.66), II (17.9%; HRadj: 2.58; 95% CI: 1.43 to 4.67), and III (27.6%; HRadj: 4.21; 95% CI: 2.25 to 7.86) than in those with normal diastolic function (6.9%). The difference in clinical outcome emerged within 30 days, was driven by cardiovascular death, and maintained in a sensitivity analysis of patients with normal systolic LV function. Furthermore, LVDD grades I (HRadj: 2.36; 95% CI: 1.17 to 4.74), II (HRadj: 2.58; 95% CI: 1.42 to 4.66), and III (HRadj: 4.41; 95% CI: 2.37 to 8.20) were independent predictors of 1-year mortality.
Conclusions Advancing stages of LVDD are associated with an incremental risk of all-cause mortality after TAVR, driven by cardiovascular death and taking effect as early as 30 days after the intervention.
- aortic stenosis
- clinical outcomes
- diastolic dysfunction
- transcatheter aortic valve replacement
Dr. Räber has received institutional research grants from Biotronik, Sanofi, and Regeneron. Prof. Windecker has received research grants to his institution from Abbott, Amgen, Boston Scientific, Biotronik, and St. Jude Medical. Prof. Pilgrim has received research grants to his institution from Edwards Lifesciences, Symetis, and Biotronik; has received speaker fees from Boston Scientific; and has received reimbursement for travel expenses from St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 4, 2017.
- Revision received December 11, 2017.
- Accepted January 1, 2018.
- 2018 American College of Cardiology Foundation