Diastolic Function and Transcatheter Aortic Valve Replacement

Background: Little is known about baseline diastolic function and changes in diastolic dysfunction (DD) grade after transcatheter aortic valve replacement (TAVR). The data published are small series with limited follow-up. The aim of this study was to describe baseline DD and changes in its grade over time after TAVR and their relation to mortality.

Methods: A single center study evaluating all TAVR between January 2008 and December 2018. Parameters of DD grade were compared between patients with and without DD grade 2 at baseline. Median follow up time after TAVR was 482 [110-1056] days.

Results: The study included 435 pts (mean age 81.6±7.3, 47.4% females) who underwent TAVR for symptomatic severe AS. DD decreased from 20.7% (90 pts) at baseline to 10.7% (15 pts) after TAVR. There were improvements in individual parameters of DD grade as E/A (p=0.032), e` lateral, E/e` and left atrial volume index (non-significant trends), in the setting of improvement of aortic valve area and gradients. Multivariate Cox regression analysis revealed that only baseline DD grade, but not post TAVR DD, or changes in DD grade was associated with increased mortality rate HR 1.84, 95% CI [ 0.99-3.71], p=0.091).

Conclusions: In this single center retrospective study of patients with symptomatic severe AS who underwent TAVR, we observed improvement in diastolic parameters. The improvement was noted at 1-year after TAVR. Baseline DD grade was the most important echocardiographic parameter associated with survival. DD should be considered in the evaluation of patients planned for TAVR.