Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Kampaktsis Polydoros
Dissertation committee:
Εμμανουήλ Βαβουρανάκης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δημήτριος Τούσουλης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευστάθιος Ηλιοδρομίτης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Τσιούφης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Γεράσιμος Σιάσος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Θεόδωρος Παπαιωάννου, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλέξανδρος Μπριασούλης, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Επιδραση προυπάρχουσας διαστολικής δυσλειτουργίας στην βραχυπρόθεσμη και μακροπρόθεσμη έκβαση ασθενών με στένωση αορτικής που υπέκεινται σε διακαθετηριακή αντικατάσταση αορτικής βαλβίδας
Translated title:
Effect of diastolic dysfunction on outcomes of patients with severe aortic stenosis undergoing transcatheter aortic valve replacement
Summary:
Background and goals: Prior studies have shown that left ventricular diastolic dysfunction (DD) may be associated with worse outcomes after aortic valve replacement. Studies on transcatheter aortic valve replacement (TAVR) were limited, have not taken into account mitral annular calcification (MAC), which limits the use of mitral valve annular Tissue Doppler imaging, and have not shown the predictive value of DD beyond pulmonary hypertension. We performed a single-center retrospective analysis to better evaluate the role of baseline DD on outcomes after TAVR.
Methods: After excluding patients with atrial fibrillation, mitral valve prostheses and significant mitral stenosis, 359 consecutive TAVR patients were included. Moderate-to-severe MAC was present in 58% of the patients. We classified patients into severe vs. non-severe DD based on the evaluation of elevated left ventricular filling pressures. The outcome measure was all-cause mortality or heart failure hospitalization. Secondary, subgroup analyses were performed to investigate the role of DD in patients that develop paravalvular leak (PVL).
Results: Over a mean follow-up time of 13 months, severe DD was associated with an increased risk for the outcome measure (HR 2.02 (1.23-3.30), p=0.005). However, this association was lost in a propensity-matched cohort that took into account pulmonary hypertension. In multivariate analysis, STS score was the only independent predictor of all cause mortality of heart failure hospitalization (HR 1.1 (1.05-1.15), p<0.001). Patients with severe DD that develop even mild PVL after TAVR had an independent risk for increased mortality (HR 3.89, CI 1.76–8.6, p=0.001)
Conclusions: Severe DD was associated with increased all-cause mortality or heart failure hospitalization after TAVR but not independently of pulmonary hypertension and other known predictors of mortality. Severe DD may be particularly detrimental in patients who develop PVL via acute volume overload of a stiff left ventricle.
Main subject category:
Health Sciences
Keywords:
Diastolic dysfunction, Aortic stenosis, Transcatheter aortic valve replacement
Number of references:
107
