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Impact of diastolic dysfunction on long‐term mortality and quality of life after transcatheter aortic valve replacement
Author(s) -
AnanthaNarayanan Mahesh,
Malik Umair,
Mbai Mackenzi,
Megaly Michael,
Florea Viorel,
Sharma Alok,
Cavalcante João L.,
Garcia Santiago
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28444
Subject(s) - medicine , interquartile range , cardiology , stenosis , valve replacement , quality of life (healthcare) , diastole , aortic valve replacement , aortic valve , surgery , blood pressure , nursing
Background There is conflicting data as to whether diastolic dysfunction (DD) affects the prognosis of patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods Consecutive patients undergoing TAVR underwent assessment of DD with preoperative echocardiography and NT‐pro BNP. Long‐term survival was ascertained every 6 months by clinic visits or phone. DD was graded according to the new American Society of Echocardiography recommendations. Health status was assessed at baseline and 30 days post‐procedure using the KCCQ‐12 questionnaire. Long‐term survival was displayed using Kaplan–Meier curves according to NT‐pro BNP levels and DD grades. Results We included 222 patients, mean age 78 (±8) years, median STS score 4 (interquartile range = 3–7), median follow‐up time 385 days (IQR = 180–640). DD was absent in 25, Grade I in 13, Grade II in 74, Grade III in 24, and indeterminate in 86 patients. Advanced (Grades II–III) DD was associated with higher pre‐procedural NT‐pro BNP levels ( p < .001), worse quality of life ( p < .001) but similar surgical risk ( p = .43). Advanced and indeterminate DD were associated with increased long‐term mortality (25–28% vs. 5%, p = .02) and elevated NT‐pro BNP levels (26.4% vs. 9.8%, p = .05). Improvements in quality of life measures were seen in all DD groups (median change in KCCQ score no or Grade I DD:14 [3–21] vs. Grades II–III DD: 15 [16–26; p = .37]). Conclusion Preoperative NT‐pro BNP levels and echocardiographic indices of indeterminate or advanced DD are associated with increased long‐term mortality after TAVR but similar improvements in quality of life.