Abstract 17785: Discordance Between Reversal of Hemodynamic and Diastolic Parameters Post Aortic Valve Replacement with Preserved Ejection Fraction

Abstract

Background: Left ventricular hypertrophy and fibrosis are known consequences of severe aortic stenosis even with normal left ventricular ejection fraction, thus resulting in diastolic dysfunction and LV filling pressure abnormalities. However, hemodynamic and diastolic recovery post AVR is not well defined.

Methods: 54 patients (76 + 10 yrs, 50% male) with severe aortic stenosis and normal ejection fraction undergoing aortic valve replacement. All patients had pre- and post-AVR echo studies. Mitral E/A ratio, mitral E-deceleration time (DT), septal and lateral e, septal and average E/e were measured. Study cohort echocardiograms were grouped into those with early post-AVR (< 6 months, n = 28) and late post-AVR (> 6 months, n = 26) using their respective baseline pre-AVR echo study as controls.

Results: In the early post-AVR period (< 6 months), the average E/e was significantly reduced (14.3 + 5.9 to 11.3 + 4.7, p = 0.04). Although the E/A ratio improved (1.46 + 0.87 to 1.21 + 0.57, p = 0.01), all other diastolic parameters did not show statistical significance (mitral E- deceleration time: 229 + 74 msec to 246 + 86 msec, p = NS, septal e’: 6.8 + 2.2 cm/sec to 6.9 + 2.6 cm/sec, p = NS, lateral e’: 6.1 + 2.3 cm/sec to 6.0 + 2.9 cm/sec, p = NS). However, in the late post-AVR period (> 6 months), the mitral E-deceleration time improved (295 + 77 msec to 248 + 92 msec, p = 0.03), the septal e trended towards improvement (6.0 + 2.0 cm/sec to 7.0 + 2.0 cm/sec, p = 0.07), and the lateral e improved (8.0 + 3.0 cm/sec to 10.0 + 3.0 cm/sec, p = 0.04). E/A ratio did not show statistical significance (0.91 + 0.4 to 1.02 + 0.4, p = NS).

Conclusion: Both Left ventricular filling pressures and diastolic function improve after successful AVR. Improvement of Left ventricular filling pressures precedes that of diastolic parameters.