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Predictors of improvement in diastolic function after transcatheter aortic valve implantation

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Abstract

Background

Aortic stenosis is associated with concentric left ventricle (LV) hypertrophy or remodeling resulting in impaired diastolic function and elevated left-sided filling pressure. We investigated the changes in LV geometry and LV filling hemodynamics, giving emphasis to parameters associated with changes in diastolic function after transcatheter aortic valve implantation (TAVI).

Methods

Comprehensive diastolic assessment was performed before and six months after TAVI in 70 patients with severe aortic stenosis. Patients with any degree of mitral stenosis or >mild left-sided valvular regurgitation were excluded.

Results

In the entire cohort six months after TAVI, LV end-diastolic diameter increased (44.1 ± 6 versus 45 ± 6 mm, P = 0.02), whereas LV mass and relative wall thickness (RWT) decreased (270.1 ± 76 versus 245.1 ± 75 g and 0.53 ± 0.15 versus 0.46 ± 0.1, respectively; P < 0.0001 for both). Lateral e′ increased (5.8 ± 2 versus 6.6 ± 3 cm/s, P = 0.03) and left atrium (LA) volume, E/e′ ratio, and systolic pulmonary pressure decreased (88.1 ± 30 versus 80 ± 28 cc, 18 ± 7.8 versus 16.3 ± 5.5, and 42.7 ± 14.9 versus 38.7 ± 12 mmHg, respectively; P < 0.05 for all), suggesting reduction in LA pressure. The improvement in LA volume and E/e′ was almost exclusively seen in patients with LV hypertrophy before TAVI (P < 0.05 both), as opposed to patients with concentric remodeling.

Conclusions

In our preliminary study, TAVI resulted in LV and LA reverse remodeling, and improved LV relaxation and LA filling pressure in patients with severe aortic stenosis and concentric hypertrophy. Patients with concentric remodeling at baseline seem to have limited improvement in LV diastolic function and filling pressure following TAVI, but larger clinical trials would be required to conclude if they have no improvement at all.

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Conflict of interest

Dr. Ariel Finkelstein receives consultation fees from Medtronic Cardiovascular and Edwards Lifesciences. All other authors declare no potential conflicts of interest.

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Authors and Affiliations

  1. Department of Cardiology, The Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv, Israel

    Konigstein Maayan, Biner Simon, Topilsky Yan, Abramowitz Yigal, Havakuk Ofer, Ben-Assa Eyal, Leshem-Rubinow Eran, Arbel Yaron, Keren Gad, Banai Shmuel & Finkelstein Ariel

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Konigstein Maayan, Biner Simon, Topilsky Yan, Abramowitz Yigal, Havakuk Ofer, Ben-Assa Eyal, Leshem-Rubinow Eran, Arbel Yaron, Keren Gad, Banai Shmuel & Finkelstein Ariel

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  1. Konigstein Maayan
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  2. Biner Simon
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  3. Topilsky Yan
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Corresponding author

Correspondence to Konigstein Maayan.

Additional information

K. Maayan and B. Simon contributed equally to the design and implementation of the study.

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Maayan, K., Simon, B., Yan, T. et al. Predictors of improvement in diastolic function after transcatheter aortic valve implantation. J Echocardiogr 12, 17–23 (2014). https://doi.org/10.1007/s12574-013-0195-8

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  • DOI: https://doi.org/10.1007/s12574-013-0195-8

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