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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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.

元の言語English
ページ(範囲)558-566
ページ数9
ジャーナルCirculation Journal
81
発行部数4
DOI
出版物ステータスPublished - 2017

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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