AIMS: Despite expected improvement in left ventricular (LV) systolic and diastolic function after transcatheter aortic valve implantation (TAVI), the complex relationship between pre-existent LV systolic and diastolic function and changes in LV haemodynamics and clinical symptoms have been scarcely investigated. This study investigated the presence of pre-operative LV diastolic dysfunction and its improvement over time after TAVI alongside improvement in New York Heart Association (NYHA) class in high-risk patients with severe aortic stenosis. METHODS AND RESULTS: The study population (n = 358) was divided into two groups according to baseline LV ejection fraction (LVEF): LVEF < 50% (n = 96) and LVEF ≥ 50% (n = 262). We compared clinical and echocardiographic parameters between groups before TAVI, at 6 and 12 months follow-up. Grade III LV diastolic dysfunction was more frequent in patients with LVEF < 50% compared with patients with LVEF ≥ 50% (50.0 vs. 16.3%, P < 0.001). Systolic and diastolic echocardiographic parameters improved after TAVI together with improvement in NYHA class both in patients with LVEF < 50% (diastolic dysfunction grade ≥2: baseline 100% of patients; 12 months 58.8%, P < 0.001; NYHA III/IV: baseline, 93.8%; 12 months, 9.7%, P < 0.001) and with LVEF ≥ 50% (diastolic dysfunction grade ≥2: baseline, 87.1%; 12 months, 61.2%; NYHA III/IV: baseline, 74.5%; 12 months, 2.6%, P < 0.001). All-cause mortality was comparable between groups. CONCLUSION: TAVI exerts favourable effects on LV systolic and diastolic function with a remarkable improvement in LV diastolic function associated with improvement in NYHA functional class at follow-up. Prognosis at 1 year after TAVI was not influenced by baseline LV diastolic dysfunction both in patients with and without LV systolic dysfunction.
Sustained favourable haemodynamics 1 year after TAVI : improvement in NYHA functional class related to improvement of left ventricular diastolic function / M. Muratori, L. Fusini, G. Tamborini, P. Gripari, V. Delgado, N.A. Marsan, S. Ghulam Ali, P. Barbier, A.L. Bartorelli, F. Alamanni, M. Pepi. - In: EUROPEAN HEART JOURNAL. CARDIOVASCULAR IMAGING. - ISSN 2047-2404. - 17:11(2016 Nov), pp. 1269-1278.
|Titolo:||Sustained favourable haemodynamics 1 year after TAVI : improvement in NYHA functional class related to improvement of left ventricular diastolic function|
FUSINI, LAURA (Secondo)
ALAMANNI, FRANCESCO (Penultimo)
|Parole Chiave:||doppler echocardiography; diastolic function; transcatheter aortic valve implantation|
|Settore Scientifico Disciplinare:||Settore MED/23 - Chirurgia Cardiaca|
|Data di pubblicazione:||nov-2016|
|Data ahead of print / Data di stampa:||20-nov-2015|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1093/ehjci/jev306|
|Appare nelle tipologie:||01 - Articolo su periodico|