The presence of left ventricle diastolic dysfunction (LVDD) was not found to affect the improvement in the health status of patients undergoing transcatheter aortic valve replacement (TAVR), according to a study results published in the Journal of the American College of Cardiology: Cardiovascular Interventions.
In this study, investigators examined the data of patients who underwent commercial TAVR between January 2012 and October 2017 at Saint Luke’s Mid America Heart Institute in Kansas City, Missouri. Doctors evaluated disease-specific health status at baseline and at 1- and 12-month follow-ups using the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ). Data were missing for 12.1% and 41.3% of study participants at the 1- and 12-month follow-ups, respectively.
The final cohort of 304 patients (mean age, 81.1±8.5 years) had mean KCCQ-OS scores post-TAVR of 47.1±25.4 at baseline, of 68.5±23.1 at 1 month, and of 68.4±24.1 at 12 months. Patients with more severe LVDD had worse health status at baseline, but their KCCQ-OS scores were comparable at both follow-ups. Composite health outcomes at the 12-month follow-up were comparable across LVDD grades. However, patients with a low vs high LVDD grade had a higher mortality rate (P =.03).
Study limitations include the small cohort from a single-center, and the fact that moderate differences may not have been detected at follow-up. In addition, LVDD was diagnosed solely based on echocardiographic parameters, which may have biased selection.
“[B]aseline LVDD is not associated with the health status benefits of TAVR and … physicians and patients need not alter their expectations of health status benefit based upon patients’ extent of LVDD,” concluded the study authors.
Malik AO, Omer M, Pflederer MC, et al. Association between diastolic dysfunction and health status outcomes in patients undergoing transcatheter aortic valve replacement [published online November 27, 2019]. JACC Cardiovasc Interv. doi: 10.1016/j.jcin.2019.08.036