LV diastolic pressures after TAVR may confer worse outcomes
Patients with increases in left ventricular diastolic pressures after successful transcatheter aortic valve replacement had elevated risk for adverse outcomes, according to data presented at the American College of Cardiology Scientific Session.
Jiwon Seo, PhD, assistant professor at Yonsei University College of Medicine in Seoul, and colleagues analyzed data from 124 patients with severe aortic stenosis who underwent TAVR. Mean LV diastolic pressures were calculated by averaging pre-A pressure, LV minimal pressure and LV end-diastolic pressure. This information was used to group patients as those who had no change or a decrease in mean LV diastolic pressure after TAVR (n = 51; mean age, 83 years; 47% men) or those who had an increase in the measure (n = 73; mean age, 80 years; 44% men).
The primary endpoint was a composite of all-cause death and unplanned CV admission, which included conditions such as angina, HF, systemic thromboembolism, atrial or ventricular tachyarrhythmia, MI or stroke.
Patients with increases in LV diastolic pressure after TAVR were often younger and had atrial fibrillation (24.7% vs. 3.9%; P = .004) and diabetes (48% vs. 25.5%; P = .019) compared with those with no changes or decreases in mean LV diastolic pressure. These patients also had significantly lower LV diastolic pressures before the procedure and had less severe aortic stenosis.
During a median follow-up of 973 days, patients with increases in LV diastolic pressure had more instances of the primary outcome (37% vs. 17.6%; P = .033) and CV death (13.7% vs. 2%; P = .052) compared with those with no changes or decreases.
Kaplan-Meier curves showed that patients with increases in LV diastolic pressures after TAVR had worse outcomes regarding the primary outcome (P = .011) and all-cause death (P = .018) compared with those with no changes or decreases.
An increase in mean LV diastolic pressure after TAVR was an independent predictor of the primary outcome (HR = 3.03; 95% CI, 1.34-6.84) and all-cause death (HR = 4.57; 95% CI, 1.51-13.81).
“The presence of an increase in left ventricular diastolic pressures after TAVR was independently associated with poorer long-term outcomes,” Seo said during the presentation. – by Darlene Dobkowski
Seo J, et al. Young Investigator Awards: Clinical Investigations. Presented at: American College of Cardiology Scientific Session; March 28-30, 2020 (virtual meeting).
Disclosure: Seo reports no relevant financial disclosures.