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

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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

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Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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