Impact of mitral annular displacement on left ventricular diastolic function improvement after transcatheter aortic valve implantation

Hiroto Utsunomiya, Hirotsugu Mihara, Yuji Itabashi, Robert J. Siegel, Tarun Chakravarty, Hasan Jilaihawi, Raj R. Makkar, Takahiro Shiota

Research output: Contribution to journalArticle

Abstract

Background: The clinical significance of left ventricular (LV) diastolic function (DF) improvement after transcatheter aortic valve implantation (TAVI) is not fully elucidated. We sought to investigate the long-term clinical and hemodynamic effects of post-TAVI DF improvement and to identify its determinants. Methods and Results: Clinical and serial echocardiographic data before and after TAVI were retrospectively reviewed together with measurement of mitral annular displacement (MAD) representing longitudinal myocardial function in 98 patients with severe aortic stenosis and ejection fraction >55%. DF grade was determined as 0–III according to the current guideline. Patients with ≥1-grade improvement in DF at 1 year (n=59, 60%) showed a better recovery of New York Heart Association functional class, plasma B-type natriuretic peptide level, stroke volume index, and averaged e’, and a greater decrease in systolic pulmonary artery pressure than those without DF improvement (all P<0.05). Coronary artery disease (odds ratio (OR), 0.30; 95% confidence interval (CI), 0.11–0.84; P=0.022) and averaged MAD (per 2.5 mm increase; OR, 4.11; 95% CI, 2.18–7.72; P<0.001) were predictors of post-TAVI DF improvement. An averaged MAD cutoff value of 10.7 mm discriminated cases of improvement with a sensitivity of 88% and specificity of 64%. Conclusions: Post-TAVI DF improvement may be associated with preserved LV longitudinal function and when present may be accompanied by more favorable clinical and hemodynamic changes.

Original languageEnglish
Pages (from-to)558-566
Number of pages9
JournalCirculation Journal
Volume81
Issue number4
DOIs
Publication statusPublished - 2017

Fingerprint

Left Ventricular Function
Hemodynamics
Odds Ratio
Confidence Intervals
Brain Natriuretic Peptide
Aortic Valve Stenosis
Stroke Volume
Pulmonary Artery
Coronary Artery Disease
Transcatheter Aortic Valve Replacement
Guidelines
Pressure
Sensitivity and Specificity

Keywords

  • Aortic stenosis
  • Diastolic function
  • Echocardiography
  • Mitral annular displacement
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of mitral annular displacement on left ventricular diastolic function improvement after transcatheter aortic valve implantation. / Utsunomiya, Hiroto; Mihara, Hirotsugu; Itabashi, Yuji; Siegel, Robert J.; Chakravarty, Tarun; Jilaihawi, Hasan; Makkar, Raj R.; Shiota, Takahiro.

In: Circulation Journal, Vol. 81, No. 4, 2017, p. 558-566.

Research output: Contribution to journalArticle

Utsunomiya, Hiroto ; Mihara, Hirotsugu ; Itabashi, Yuji ; Siegel, Robert J. ; Chakravarty, Tarun ; Jilaihawi, Hasan ; Makkar, Raj R. ; Shiota, Takahiro. / Impact of mitral annular displacement on left ventricular diastolic function improvement after transcatheter aortic valve implantation. In: Circulation Journal. 2017 ; Vol. 81, No. 4. pp. 558-566.
@article{7e740d728baa428c80f7247f3f117857,
title = "Impact of mitral annular displacement on left ventricular diastolic function improvement after transcatheter aortic valve implantation",
abstract = "Background: The clinical significance of left ventricular (LV) diastolic function (DF) improvement after transcatheter aortic valve implantation (TAVI) is not fully elucidated. We sought to investigate the long-term clinical and hemodynamic effects of post-TAVI DF improvement and to identify its determinants. Methods and Results: Clinical and serial echocardiographic data before and after TAVI were retrospectively reviewed together with measurement of mitral annular displacement (MAD) representing longitudinal myocardial function in 98 patients with severe aortic stenosis and ejection fraction >55{\%}. DF grade was determined as 0–III according to the current guideline. Patients with ≥1-grade improvement in DF at 1 year (n=59, 60{\%}) showed a better recovery of New York Heart Association functional class, plasma B-type natriuretic peptide level, stroke volume index, and averaged e’, and a greater decrease in systolic pulmonary artery pressure than those without DF improvement (all P<0.05). Coronary artery disease (odds ratio (OR), 0.30; 95{\%} confidence interval (CI), 0.11–0.84; P=0.022) and averaged MAD (per 2.5 mm increase; OR, 4.11; 95{\%} CI, 2.18–7.72; P<0.001) were predictors of post-TAVI DF improvement. An averaged MAD cutoff value of 10.7 mm discriminated cases of improvement with a sensitivity of 88{\%} and specificity of 64{\%}. Conclusions: Post-TAVI DF improvement may be associated with preserved LV longitudinal function and when present may be accompanied by more favorable clinical and hemodynamic changes.",
keywords = "Aortic stenosis, Diastolic function, Echocardiography, Mitral annular displacement, Transcatheter aortic valve implantation",
author = "Hiroto Utsunomiya and Hirotsugu Mihara and Yuji Itabashi and Siegel, {Robert J.} and Tarun Chakravarty and Hasan Jilaihawi and Makkar, {Raj R.} and Takahiro Shiota",
year = "2017",
doi = "10.1253/circj.CJ-16-1105",
language = "English",
volume = "81",
pages = "558--566",
journal = "Circulation Journal",
issn = "1346-9843",
publisher = "Japanese Circulation Society",
number = "4",

}

TY - JOUR

T1 - Impact of mitral annular displacement on left ventricular diastolic function improvement after transcatheter aortic valve implantation

AU - Utsunomiya, Hiroto

AU - Mihara, Hirotsugu

AU - Itabashi, Yuji

AU - Siegel, Robert J.

AU - Chakravarty, Tarun

AU - Jilaihawi, Hasan

AU - Makkar, Raj R.

AU - Shiota, Takahiro

PY - 2017

Y1 - 2017

N2 - Background: The clinical significance of left ventricular (LV) diastolic function (DF) improvement after transcatheter aortic valve implantation (TAVI) is not fully elucidated. We sought to investigate the long-term clinical and hemodynamic effects of post-TAVI DF improvement and to identify its determinants. Methods and Results: Clinical and serial echocardiographic data before and after TAVI were retrospectively reviewed together with measurement of mitral annular displacement (MAD) representing longitudinal myocardial function in 98 patients with severe aortic stenosis and ejection fraction >55%. DF grade was determined as 0–III according to the current guideline. Patients with ≥1-grade improvement in DF at 1 year (n=59, 60%) showed a better recovery of New York Heart Association functional class, plasma B-type natriuretic peptide level, stroke volume index, and averaged e’, and a greater decrease in systolic pulmonary artery pressure than those without DF improvement (all P<0.05). Coronary artery disease (odds ratio (OR), 0.30; 95% confidence interval (CI), 0.11–0.84; P=0.022) and averaged MAD (per 2.5 mm increase; OR, 4.11; 95% CI, 2.18–7.72; P<0.001) were predictors of post-TAVI DF improvement. An averaged MAD cutoff value of 10.7 mm discriminated cases of improvement with a sensitivity of 88% and specificity of 64%. Conclusions: Post-TAVI DF improvement may be associated with preserved LV longitudinal function and when present may be accompanied by more favorable clinical and hemodynamic changes.

AB - Background: The clinical significance of left ventricular (LV) diastolic function (DF) improvement after transcatheter aortic valve implantation (TAVI) is not fully elucidated. We sought to investigate the long-term clinical and hemodynamic effects of post-TAVI DF improvement and to identify its determinants. Methods and Results: Clinical and serial echocardiographic data before and after TAVI were retrospectively reviewed together with measurement of mitral annular displacement (MAD) representing longitudinal myocardial function in 98 patients with severe aortic stenosis and ejection fraction >55%. DF grade was determined as 0–III according to the current guideline. Patients with ≥1-grade improvement in DF at 1 year (n=59, 60%) showed a better recovery of New York Heart Association functional class, plasma B-type natriuretic peptide level, stroke volume index, and averaged e’, and a greater decrease in systolic pulmonary artery pressure than those without DF improvement (all P<0.05). Coronary artery disease (odds ratio (OR), 0.30; 95% confidence interval (CI), 0.11–0.84; P=0.022) and averaged MAD (per 2.5 mm increase; OR, 4.11; 95% CI, 2.18–7.72; P<0.001) were predictors of post-TAVI DF improvement. An averaged MAD cutoff value of 10.7 mm discriminated cases of improvement with a sensitivity of 88% and specificity of 64%. Conclusions: Post-TAVI DF improvement may be associated with preserved LV longitudinal function and when present may be accompanied by more favorable clinical and hemodynamic changes.

KW - Aortic stenosis

KW - Diastolic function

KW - Echocardiography

KW - Mitral annular displacement

KW - Transcatheter aortic valve implantation

UR - http://www.scopus.com/inward/record.url?scp=85016184057&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85016184057&partnerID=8YFLogxK

U2 - 10.1253/circj.CJ-16-1105

DO - 10.1253/circj.CJ-16-1105

M3 - Article

C2 - 28132982

AN - SCOPUS:85016184057

VL - 81

SP - 558

EP - 566

JO - Circulation Journal

JF - Circulation Journal

SN - 1346-9843

IS - 4

ER -