Abstract 4782: Diastolic Dysfunction may Explain Adverse Outcomes in Patient-Prosthesis Mismatch of the Aortic Valve
Background: The effect of patient prosthesis mismatch (PPM) on outcome is controversial. We hypothesized that the adverse effect attributed to PPM is actually due to diastolic dysfunction (DD) in pts with small hearts. We therefore sought the association between PPM, diastolic dysfunction and outcome.
Methods: Echo-Doppler was performed in 169 pts before and after aortic valve replacement (AVR). In vivo effective orifice areas (EOA) for each prosthesis type and size were obtained from published values of normally functioning prostheses. PPM was identified from the predicted indexed orifice area (iEOA), obtained by dividing the EOA by body surface area. DD was classed as normal, delayed relaxation (DR; prolonged deceleration time for age), raised LA pressure (RLAP; increased E/E′, left atrial enlargement, short deceleration time), and equivocal (including AF). Events (hospitalisations and all-cause mortality following AVR) were determined over a follow-up of 3±2 years.
Results: PPM was found in 93 (55%) of patients. Of the pts with PPM, no DD was present on the post-operative echo in 20 pts (22%); DR in 31 (33%), RLAP in 33 (35%) and 10% were equivocal. There were 32 events (12 deaths and 20 hospitalizations); 2 in the no DD group (10%), 11 in DR (35%), 16 in RLAP (48%) and 3 in the remainder. DD (p=0.03, see figure⇓) but not age (p=0.38), LVEF (p=0.11) or severity of PPM (p=0.19) were associated with events.
Conclusions: PPM was associated with 13% mortality and 34% composite event rate over 3 year follow-up. Events were significantly associated with DD.