Abstract 19912: Prognostic Value of Restrictive Left Ventricular Filling in Patients Undergoing Trans-catheter or Surgical Aortic Valve Replacement
Objectives: We evaluated prognostic value of restrictive left ventricular (LV) filling in patients with severe aortic stenosis (AS) undergoing trans-catheter (TAVR) or surgical aortic valve replacements (SAVR).
Methods: We included the patients with AS who had successful TAVR or SAVR at our institution. Restrictive filling was defined as: mitral E/A ≥ 2 and mitral deceleration time (DT) < 120ms.
Results: Of the 238 patients evaluated, 132 patients (55%) had a restrictive LV filling. Mean age (85±8 vs. 85±8, p =0.546) and STS score (11.2±3 vs. 11.0±2.5, p = 0.244) were similar but more male patients (62% vs. 47%, p = 0.021) in the group with vs. without restrictive filling. LV ejection fraction (LVEF) was significantly lower (54±15 vs. 63±12, p <0.001) and LV mass (LVM) was significantly higher (231±86 vs. 196±71, p = 0.003) in patients with restrictive vs. without restrictive filling. Patients with vs. without restrictive filling had: TF-TAVR in 49% vs. 57% patients, TA-TAVR in 18% vs. 14% patients, and SAVR in 33% vs. 29%. After procedure LVEF (54±15% to 57±14%, p = 0.005) and LVM (239±90 vs. 211±67, p < 0.001) improved significantly in patients with restrictive filling. 1-year mortality was 27% in patients with restrictive filling vs. 12% in patients with PASP < 50mmHg (p = 0.005) (Figure). Patients with vs. without persistent restrictive filling at 1 month of follow-up had worst 1-year mortality (31% vs. 12%, p = 0.004). In the Cox regression analysis, restrictive LV filling pattern was most significant predictor of 1-year mortality (HR 2.8, 95% CI 1.3-6.1, p value= 0.008) and PAP and LVM was independent predictor of restrictive LV filling.
Conclusions: Restrictive LV filling is associated with an increased mortality after TAVR and SAVR. After procedure there is significant reverse remodeling but persistent restrictive filling is associated with poor outcomes.
Author Disclosures: A.M. Rafique: None. H. Jilaihawi: None. T. Chakravarty: None. N. Doctor: None. M. Kashif: None. M. Gheorghiu: None. W. Cheng: None. R. Makkar: None.
- © 2014 by American Heart Association, Inc.