Medium and long-term prognosis of transcatheter aortic valve implantation from the perspective of left ventricular diastolic function

The effects of left ventricular (LV) diastolic function are well known in cardiac surgery, but unclear in transcatheter aortic valve implantation (TAVI). The objective of this study was to exam- ine the association of preoperative LV diastolic function with medium to long-term outcomes of TAVI. Eighty patients who underwent TAVI were classified into grades I, II and III based on pre- operative LV diastolic function. Findings related to cardiovascular outcomes after TAVI were extracted retrospectively from clinical and echocardiographic data and relationships with diastolic function were examined. The average follow-up was 529 days (interquartile range {IQR] 358-741 days). Cardiovascu- lar events occurred in 17 cases, including 6 deaths, and were significantly associated with Euro II score (p = 0.043), albumin level (p = 0.026), coronary artery disease (CAD) (p = 0.017), and diastolic func- tion (p < 0.001). The 360-day event-free rates were 89.5%, 89.5% and 37.5% for grades I, II and III (p = 0.00013). Median event-free survival (EFS) in grade III cases was 180 days. In a Cox propor- tional hazard model, LV diastolic dysfunction (hazard ratio [HR] 3.99, 95% confidence interval [CI] 1.35-11.80, p = 0.012) and low albumin (HR 4.73, 95% CI 1.42-15.80, p = 0.012) were significant independent predictors of reduced EFS. Medium to long-term outcomes of TAVI were poorer in patients with deteriorated LV diastolic function, and outcomes in grade III cases were significantly worse than those in grade I and II cases. Preoperative LV diastolic function may be useful in prediction of outcomes after TAVI.