Perioperative worsening of diastolic function after transcatheter aortic valve implantation is associated with adverse clinical outcomes in patients with heart failure with preserved ejection fraction and severe aortic stenosis.

Abstract

Purpose: This study investigated the prognostic significance of perioperative changes in diastolic function in patients with heart failure with preserved ejection fraction (HFpEF) and severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).

Methods: A total of 123 HFpEF patients (left ventricular ejection fraction ≥50%) with severe AS were evaluated using echocardiography before and within one week after TAVI. Based on changes in diastolic function, patients were classified into the control group with unchanged or improved function (n=105;85.4%) and the worsened group (n=18;14.6%). We compared patient characteristics and prognosis between the two groups.

Results: There were no significant differences in age or sex between the groups. The worsened group exhibited lower preoperative peak aortic jet velocity and lower mean aortic valve pressure gradient compared with the control group. Lower preoperative values in these parameters were associated with a higher risk of a worsened diastolic function after TAVI. Eleven major adverse cardiovascular and cerebrovascular events occurred after TAVI. Worsened diastolic function was associated with major adverse cardiovascular and cerebrovascular events (hazard ratio 5.163;p=0.007).

Conclusion: Perioperative worsening of diastolic function was associated with poor prognosis in patients with HFpEF and severe AS undergoing TAVI.