Masahiko Asami1, Jonas Lanz1, Stefan Stortecky1, Lorenz Räber1, Anna Franzone1, Dik Heg2, Lukas Hunziker1, Eva Roost3, George Cm Siontis1, Marco Valgimigli1, Stephan Windecker1, Thomas Pilgrim4. 1. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland. 2. Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland. 3. Department of Cardiac Surgery, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland. 4. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland. Electronic address: thomas.pilgrim@insel.ch.
Abstract
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.
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 stenosispatients 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.
Authors: Ali O Malik; Mohamed Omer; Mathew C Pflederer; Ahmed Almomani; Kensey L Gosch; Philip G Jones; Poghni A Peri-Okonny; Firas Al Badarin; Hunter A Brandt; Suzanne V Arnold; Michael L Main; David J Cohen; John A Spertus; Adnan K Chhatriwalla Journal: JACC Cardiovasc Interv Date: 2019-11-27 Impact factor: 11.195
Authors: Torben Lange; Sören J Backhaus; Bo Eric Beuthner; Rodi Topci; Karl-Rudolf Rigorth; Johannes T Kowallick; Ruben Evertz; Moritz Schnelle; Susana Ravassa; Javier Díez; Karl Toischer; Tim Seidler; Miriam Puls; Gerd Hasenfuß; Andreas Schuster Journal: J Cardiovasc Magn Reson Date: 2022-07-28 Impact factor: 6.903
Authors: Hassan AlHarbi; Mohammed AlAhmari; Abdulrahman M Alanazi; Bander Al-Ghamdi; Abdullah AlSuayri; Ahmed AlHaydhal; Amr A Arafat; Khaled D Algarni; Wiam Abdelsalam; Sameera AlRajwi; Abdulrahman AlMoghairi; Hussin AlAmri; Saeed AlAhmari; Mohammed AlOtaiby Journal: J Saudi Heart Assoc Date: 2021-04-19
Authors: Anthony A Bavry; Taishi Okuno; Seyed Hossein Aalaei-Andabili; Dharam J Kumbhani; Stefan Stortecky; Masahiko Asami; Jonas Lanz; Stephan Windecker; Thomas Pilgrim Journal: Clin Cardiol Date: 2020-09-22 Impact factor: 2.882