Influence of aortic regurgitation after TAVI on left ventricular filling pattern

Background Paravalvular aortic regurgitation after transcatheter aortic valve implantation is associated with a hemodynamic deterioration and a poor outcome. We aim to determine the early hemodynamic effect of paravalvular aortic regurgitation in relation with the change in the left ventricle fillin...

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Published in:European journal of clinical investigation 2015-01, Vol.45 (1), p.18-26
Main Authors: Caballero, Luis, Saura, Daniel, García-Lara, Juan, Oliva, Maria José, Pinar, Eduardo, González-Carrillo, Josefa, García-Navarro, Miguel, Espinosa, Maria Dolores, Valdés, Mariano, de la Morena, Gonzalo
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aortic Valve Insufficiency - etiology
Aortic Valve Insufficiency - physiopathology
Aortic Valve Stenosis - surgery
Diastolic function
Disease Progression
Echocardiography - methods
Female
Humans
Male
paravalvular aortic regurgitation
Transcatheter aortic valve implantation
Transcatheter Aortic Valve Replacement - adverse effects
Treatment Outcome
Ventricular Dysfunction, Left - etiology
Ventricular Dysfunction, Left - physiopathology
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Summary:Background Paravalvular aortic regurgitation after transcatheter aortic valve implantation is associated with a hemodynamic deterioration and a poor outcome. We aim to determine the early hemodynamic effect of paravalvular aortic regurgitation in relation with the change in the left ventricle filling pattern and to assess their clinical outcome. Material and methods Eighty‐two consecutive patients referred for transcatheter aortic valve implantation were included. Patients were classified according to the change in the left ventricular filling pattern, and significant paravalvular aortic regurgitation (grade ≥ 2) was reported. Follow‐up and incidence of death and hospitalization for heart failure were reported. Results Sixteen patients (19·5%) presented a worsening of left ventricular filling pattern. The incidence of significant paravalvular aortic regurgitation was higher in the group with a worsening of left ventricular filling pattern (56·3% vs. 19·7%; P = 0·009). In the multivariate analysis, the only variable significantly associated with the worsening of left ventricular filling pattern was the significant paravalvular aortic regurgitation (OR 4·84; 95% CI 1·23 – 19·1; P = 0·024). During the follow‐up (642·5 days), there was a higher incidence of the endpoint of death or hospitalization for heart failure in the group with a worsening of left ventricular filling pattern (62·5% vs. 31·8%; P = 0·042) and a lower event‐free survival rate (long rank test = 0·013). Conclusions The presence of a significant paravalvular aortic regurgitation is associated with a worsening in parameters of diastolic function. This finding should alert the cardiologist as patients with a worsening of left ventricular filling pattern present a higher incidence of paravalvular aortic regurgitation and a less favourable outcome.
ISSN:0014-2972
1365-2362
DOI:10.1111/eci.12374