Diastolic Dysfunction and Long-Term Mortality After Transcatheter Aortic Valve Replacement

Background:
Diastolic dysfunction is common in patients with severe aortic stenosis. There is conflicting data as to whether diastolic dysfunction impacts long-term survival after transcatheter aortic valve replacement (TAVR).

Methods:
Consecutive patients undergoing TAVR underwent assessment of diastolic dysfunction with preoperative echocardiography and NT-proBNP. Long-term survival was ascertained every 6 months by clinic visits or phone. Diastolic dysfunction was graded according to the new American Society of Echocardiography (ASE) recommendations. Long-term survival was displayed using Kaplan-Meier curves according to NT-proBNP quartiles and diastolic dysfunction grades. Cox proportional-hazards regression analysis was used to estimate predictors of survival.

Results:
We included 214 patients, mean age 78 (±8) years, median STS score 4 (IQR: 3-7). Diastolic dysfunction (DD) grade was absent in 27 (12.6%), grade I in 13 (6%), grade II in 66 (30.8%), grade III in 23 (10.7%) and indeterminate in 85 (39%) patients. Levels of NT-proBNP, but not DD grade, were predictive of long-term mortality (Figure). Each increase in NT-proBNP quartile was associated with a hazard ratio of 1.62 (95% CI: 1.14-2.30, p=0.006).

Conclusions:
Preoperative NT-proBNP is superior to echocardiographic indices of DD for estimating long-term mortality after TAVR.