Impact of diastolic dysfunction on long-term mortality and quality of life after transcatheter aortic valve replacement

Mahesh Anantha-Narayanan; Umair Malik; Mackenzi Mbai; Michael Megaly; Viorel Florea; Alok Sharma; João L. Cavalcante; Santiago Garcia

doi:10.1002/ccd.28444

Impact of diastolic dysfunction on long-term mortality and quality of life after transcatheter aortic valve replacement

Mahesh Anantha-Narayanan, Umair Malik, Mackenzi Mbai, Michael Megaly, Viorel Florea, Alok Sharma, João L. Cavalcante, Santiago Garcia

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: There is conflicting data as to whether diastolic dysfunction (DD) affects the prognosis of patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).

METHODS: Consecutive patients undergoing TAVR underwent assessment of DD with preoperative echocardiography and NT-pro BNP. Long-term survival was ascertained every 6 months by clinic visits or phone. DD was graded according to the new American Society of Echocardiography recommendations. Health status was assessed at baseline and 30 days post-procedure using the KCCQ-12 questionnaire. Long-term survival was displayed using Kaplan-Meier curves according to NT-pro BNP levels and DD grades.

RESULTS: We included 222 patients, mean age 78 (±8) years, median STS score 4 (interquartile range = 3-7), median follow-up time 385 days (IQR = 180-640). DD was absent in 25, Grade I in 13, Grade II in 74, Grade III in 24, and indeterminate in 86 patients. Advanced (Grades II-III) DD was associated with higher pre-procedural NT-pro BNP levels (p < .001), worse quality of life (p < .001) but similar surgical risk (p = .43). Advanced and indeterminate DD were associated with increased long-term mortality (25-28% vs. 5%, p = .02) and elevated NT-pro BNP levels (26.4% vs. 9.8%, p = .05). Improvements in quality of life measures were seen in all DD groups (median change in KCCQ score no or Grade I DD:14 [3-21] vs. Grades II-III DD: 15 [16-26; p = .37]).

CONCLUSION: Preoperative NT-pro BNP levels and echocardiographic indices of indeterminate or advanced DD are associated with increased long-term mortality after TAVR but similar improvements in quality of life.

Original language	English (US)
Pages (from-to)	1034-1041
Number of pages	8
Journal	Catheterization and Cardiovascular Interventions
Volume	95
Issue number	5
DOIs	https://doi.org/10.1002/ccd.28444
State	Published - Apr 1 2020

Bibliographical note

Publisher Copyright:
© 2019 Wiley Periodicals, Inc.

Keywords

DIAS—diastolic dysfunction
HCO—health care outcomes
TVI—transcatheter valve implantation
Prospective Studies
Diastole
Risk Assessment
Ventricular Function, Left
Humans
Risk Factors
Male
Transcatheter Aortic Valve Replacement/adverse effects
Treatment Outcome
Ventricular Dysfunction, Left/diagnostic imaging
Recovery of Function
Aortic Valve Stenosis/diagnostic imaging
Time Factors
Aged, 80 and over
Quality of Life
Biomarkers/blood
Female
Aged
Peptide Fragments/blood
Aortic Valve/diagnostic imaging
Natriuretic Peptide, Brain/blood

PubMed: MeSH publication types

Observational Study
Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/ccd.28444

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title = "Impact of diastolic dysfunction on long-term mortality and quality of life after transcatheter aortic valve replacement",

abstract = "BACKGROUND: There is conflicting data as to whether diastolic dysfunction (DD) affects the prognosis of patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).METHODS: Consecutive patients undergoing TAVR underwent assessment of DD with preoperative echocardiography and NT-pro BNP. Long-term survival was ascertained every 6 months by clinic visits or phone. DD was graded according to the new American Society of Echocardiography recommendations. Health status was assessed at baseline and 30 days post-procedure using the KCCQ-12 questionnaire. Long-term survival was displayed using Kaplan-Meier curves according to NT-pro BNP levels and DD grades.RESULTS: We included 222 patients, mean age 78 (±8) years, median STS score 4 (interquartile range = 3-7), median follow-up time 385 days (IQR = 180-640). DD was absent in 25, Grade I in 13, Grade II in 74, Grade III in 24, and indeterminate in 86 patients. Advanced (Grades II-III) DD was associated with higher pre-procedural NT-pro BNP levels (p < .001), worse quality of life (p < .001) but similar surgical risk (p = .43). Advanced and indeterminate DD were associated with increased long-term mortality (25-28% vs. 5%, p = .02) and elevated NT-pro BNP levels (26.4% vs. 9.8%, p = .05). Improvements in quality of life measures were seen in all DD groups (median change in KCCQ score no or Grade I DD:14 [3-21] vs. Grades II-III DD: 15 [16-26; p = .37]).CONCLUSION: Preoperative NT-pro BNP levels and echocardiographic indices of indeterminate or advanced DD are associated with increased long-term mortality after TAVR but similar improvements in quality of life.",

keywords = "DIAS—diastolic dysfunction, HCO—health care outcomes, TVI—transcatheter valve implantation, Prospective Studies, Diastole, Risk Assessment, Ventricular Function, Left, Humans, Risk Factors, Male, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome, Ventricular Dysfunction, Left/diagnostic imaging, Recovery of Function, Aortic Valve Stenosis/diagnostic imaging, Time Factors, Aged, 80 and over, Quality of Life, Biomarkers/blood, Female, Aged, Peptide Fragments/blood, Aortic Valve/diagnostic imaging, Natriuretic Peptide, Brain/blood",

author = "Mahesh Anantha-Narayanan and Umair Malik and Mackenzi Mbai and Michael Megaly and Viorel Florea and Alok Sharma and Cavalcante, {Jo{\~a}o L.} and Santiago Garcia",

note = "Publisher Copyright: {\textcopyright} 2019 Wiley Periodicals, Inc.",

year = "2020",

month = apr,

day = "1",

doi = "10.1002/ccd.28444",

language = "English (US)",

volume = "95",

pages = "1034--1041",

journal = "Catheterization and Cardiovascular Interventions",

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T1 - Impact of diastolic dysfunction on long-term mortality and quality of life after transcatheter aortic valve replacement

AU - Anantha-Narayanan, Mahesh

AU - Malik, Umair

AU - Mbai, Mackenzi

AU - Megaly, Michael

AU - Florea, Viorel

AU - Sharma, Alok

AU - Cavalcante, João L.

AU - Garcia, Santiago

PY - 2020/4/1

Y1 - 2020/4/1

N2 - BACKGROUND: There is conflicting data as to whether diastolic dysfunction (DD) affects the prognosis of patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).METHODS: Consecutive patients undergoing TAVR underwent assessment of DD with preoperative echocardiography and NT-pro BNP. Long-term survival was ascertained every 6 months by clinic visits or phone. DD was graded according to the new American Society of Echocardiography recommendations. Health status was assessed at baseline and 30 days post-procedure using the KCCQ-12 questionnaire. Long-term survival was displayed using Kaplan-Meier curves according to NT-pro BNP levels and DD grades.RESULTS: We included 222 patients, mean age 78 (±8) years, median STS score 4 (interquartile range = 3-7), median follow-up time 385 days (IQR = 180-640). DD was absent in 25, Grade I in 13, Grade II in 74, Grade III in 24, and indeterminate in 86 patients. Advanced (Grades II-III) DD was associated with higher pre-procedural NT-pro BNP levels (p < .001), worse quality of life (p < .001) but similar surgical risk (p = .43). Advanced and indeterminate DD were associated with increased long-term mortality (25-28% vs. 5%, p = .02) and elevated NT-pro BNP levels (26.4% vs. 9.8%, p = .05). Improvements in quality of life measures were seen in all DD groups (median change in KCCQ score no or Grade I DD:14 [3-21] vs. Grades II-III DD: 15 [16-26; p = .37]).CONCLUSION: Preoperative NT-pro BNP levels and echocardiographic indices of indeterminate or advanced DD are associated with increased long-term mortality after TAVR but similar improvements in quality of life.

AB - BACKGROUND: There is conflicting data as to whether diastolic dysfunction (DD) affects the prognosis of patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).METHODS: Consecutive patients undergoing TAVR underwent assessment of DD with preoperative echocardiography and NT-pro BNP. Long-term survival was ascertained every 6 months by clinic visits or phone. DD was graded according to the new American Society of Echocardiography recommendations. Health status was assessed at baseline and 30 days post-procedure using the KCCQ-12 questionnaire. Long-term survival was displayed using Kaplan-Meier curves according to NT-pro BNP levels and DD grades.RESULTS: We included 222 patients, mean age 78 (±8) years, median STS score 4 (interquartile range = 3-7), median follow-up time 385 days (IQR = 180-640). DD was absent in 25, Grade I in 13, Grade II in 74, Grade III in 24, and indeterminate in 86 patients. Advanced (Grades II-III) DD was associated with higher pre-procedural NT-pro BNP levels (p < .001), worse quality of life (p < .001) but similar surgical risk (p = .43). Advanced and indeterminate DD were associated with increased long-term mortality (25-28% vs. 5%, p = .02) and elevated NT-pro BNP levels (26.4% vs. 9.8%, p = .05). Improvements in quality of life measures were seen in all DD groups (median change in KCCQ score no or Grade I DD:14 [3-21] vs. Grades II-III DD: 15 [16-26; p = .37]).CONCLUSION: Preoperative NT-pro BNP levels and echocardiographic indices of indeterminate or advanced DD are associated with increased long-term mortality after TAVR but similar improvements in quality of life.

KW - DIAS—diastolic dysfunction

KW - HCO—health care outcomes

KW - TVI—transcatheter valve implantation

KW - Prospective Studies

KW - Diastole

KW - Risk Assessment

KW - Ventricular Function, Left

KW - Humans

KW - Risk Factors

KW - Male

KW - Transcatheter Aortic Valve Replacement/adverse effects

KW - Treatment Outcome

KW - Ventricular Dysfunction, Left/diagnostic imaging

KW - Recovery of Function

KW - Aortic Valve Stenosis/diagnostic imaging

KW - Time Factors

KW - Aged, 80 and over

KW - Quality of Life

KW - Biomarkers/blood

KW - Female

KW - Aged

KW - Peptide Fragments/blood

KW - Aortic Valve/diagnostic imaging

KW - Natriuretic Peptide, Brain/blood

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U2 - 10.1002/ccd.28444

DO - 10.1002/ccd.28444

M3 - Article

C2 - 31419009

AN - SCOPUS:85071148940

SN - 1522-1946

VL - 95

SP - 1034

EP - 1041

JO - Catheterization and Cardiovascular Interventions

JF - Catheterization and Cardiovascular Interventions

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ER -

Impact of diastolic dysfunction on long-term mortality and quality of life after transcatheter aortic valve replacement

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

UN SDGs

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