A significant subset of patients with severe aortic stenosis showed increased left ventricular diastolic pressure (LVDP) after undergoing transcatheter aortic valve replacement (TAVR), according to study results intended to be presented at the annual meeting of the American College of Cardiology/World College of Cardiology (ACC.20/WCC), March 28-30, 2020.
Researchers examined LVDP in 151 patients undergoing TAVR for severe aortic stenosis. The mean LVDP of patients was calculated by averaging invasively measured LV minimal pressure, pre-A pressure, and LV end-diastolic pressure. Patients were stratified according to LVDP: no change or decrease in mean LVDP (n=59) or increase in LVDP (n=92). The study’s primary endpoint was a composite of all-cause death and unplanned cardiovascular rehospitalization.
There was a total of 26 rehospitalizations and 31 deaths in this cohort during the follow-up (median, 21 months).
Diabetes mellitus and atrial fibrillation were more frequently observed in patients who experienced an increase in LVDP after TAVR, although patients were younger on average in this group. In addition, in patients exhibiting an increase in average LVDP post-TAVR, pre-procedural LVDP was found to be lower, and aortic stenosis had reduced severity. An increase in mean LVDP post-TAVR was shown to be an independent predictor of adverse outcomes (hazard ratio, 3.27; 95% CI, 1.54-6.96; P =.002) in multivariate Cox proportional hazard models.
“Increase in LVDP after TAVR identifies a high-risk patient subset whose risk for adverse outcomes persists even after successful TAVR,” concluded the study authors.
Seo J, Song S, Shim CY, Hong GR, Ko YG, Hong MK, Ha JW. Paradoxical increase in left ventricular diastolic pressure after successful transcatheter aortic valve replacement is related to poorer long-term outcome in severe aortic stenosis. Intended to be presented at: American College of Cardiology’s 69th Annual Scientific Session. March 28-30, 2020.