Predictors of Improvement of Left Ventricular Diastolic Function After Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis With Preserved Left Ventricular Systolic Function: A Serial Echocardiographic Study

Background: Improvement of left ventricular (LV) diastolic function (DF) after transcatheter aortic valve replacement (TAVR) is not fully elucidated. The present serial transthoracic echocardiography study aimed to investigate the long-term clinical and hemodynamic impact of DF improvement after TAVR and to identify its predictors. Methods: We retrospectively reviewed echocardiographic and clinical data before and after TAVR in 98 patients with severe aortic stenosis (AS) and preserved LV systolic function. Mitral annular displacement was measured as the maximal distance of lateral annular motion during systole in apical 4-chamber view. DF was classified as grade 0 to 3 based on the recommendations of the American Society of Echocardiography. DF improvement was defined as ≥1 grade improvement at the 1-year follow-up. Results: Fifty-nine patients (60%) showed DF improvement. At baseline, patients with the improvement had a less severity of AS (valve area index, 0.37 ± 0.09 vs. 0.32 ± 0.08 cm2/m2) than those with no improvement. Despite similar baseline and changes in LV ejection fraction and mass index, the improvement group shows better recovery of functional status, stroke volume index, and E/e’ (Fig.1-3), as well as plasma brain natriuretic peptide level (median, 264 to 110 vs. 267 to 252 pg/ml, p = 0.017). When adjusting for age, demographic variables, valve area and change in mass index, absence of coronary artery disease (p = 0.03), mitral annular displacement (p < 0.001), and right ventricular end-diastolic diameter (p = 0.02) were independently associated with DF improvement. A mitral annular displacement >11.9 mm had a sensitivity of 83% and a specificity of 72% for prediction of DF improvement (Fig.4). Conclusion: DF improvement is often observed after TAVR and when present may be accompanied by more favorable clinical and hemodynamic changes. Mitral annular displacement, but not AS severity or degree of mass regression, predicts DF improvement after TAVR.