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    The relationship between baseline diastolic dysfunction and postimplantation invasive hemodynamics with transcatheter aortic valve replacement

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    Author
    Bavry, Anthony A
    Okuno, Taishi
    Aalaei-Andabili, Seyed Hossein
    Kumbhani, Dharam J
    Stortecky, Stefan
    Asami, Masahiko
    Lanz, Jonas
    Windecker, Stephan
    Pilgrim, Thomas
    Date
    2020-09-22
    Journal
    Clinical cardiology
    Publisher
    Wiley-Blackwell
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1002/clc.23457
    Abstract
    Background: Abnormal invasive hemodynamics after transcatheter aortic valve replacement (TAVR) is associated with poor survival; however, the mechanism is unknown. Hypothesis: Diastolic dysfunction will modify the association between invasive hemodynamics postTAVR and mortality. Methods: Patients with echocardiographic assessment of diastolic function and postTAVR invasive hemodynamic assessment were eligible for the present analysis. Diastology was classified as normal or abnormal (Stages 1 to 3). The aorto-ventricular index (AVi) was calculated as the difference between the aortic diastolic and the left ventricular end-diastolic pressure divided by the heart rate. AVi was categorized as abnormal (AVi < 0.5 mmHg/beats per minute) or normal (≥ 0.5 mmHg/beats per minute). Results: From 1339 TAVR patients, 390 were included in the final analysis. The mean follow-up was 3.3 ± 1.7 years. Diastolic dysfunction was present in 70.9% of the abnormal vs 55.1% of the normal AVi group (P <.001). All-cause mortality was 46% in the abnormal vs 31% in the normal AVi group (P <.001). Adjusted hazard ratio (HR) for AVi < 0.5 mmHg/beats per minute vs AVi ≥0.5 mmHg/beats per minute for intermediate-term mortality was (HR = 1.5, 95% confidence interval [CI] 1.1 to 2.1, P =.017). This association was the same among those with normal diastolic function and those with diastolic dysfunction (P for interaction =.35). Conclusion: Diastolic dysfunction is prevalent among TAVR patients. Low AVi is an independent predictor for poor intermediate-term survival, irrespective of co-morbid diastolic dysfunction.
    Rights/Terms
    © 2020 The Authors. Clinical Cardiology published by Wiley Periodicals LLC.
    Keyword
    aortic stenosis
    aorto-ventricular index
    diastolic dysfunction
    filling pressures
    invasive hemodynamics
    prognosis
    transcatheter aortic valve replacement
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/13786
    ae974a485f413a2113503eed53cd6c53
    10.1002/clc.23457
    Scopus Count
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