Diastolic Function and Clinical Outcomes After Transcatheter Aortic Valve Replacement: PARTNER 2 SAPIEN 3 Registry.
Diastolic Function and Clinical Outcomes After Transcatheter Aortic Valve Replacement: PARTNER 2 SAPIEN 3 Registry.
- 2020
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: Few studies have evaluated if diastolic function could predict outcomes in patients with aortic stenosis. CONCLUSIONS: In the PARTNER 2 SAPIEN 3 registry, baseline DD was a predictor of up to 2 years clinical outcomes in patients who underwent TAVR. Improvement in DD grade at 30 days was associated with improvement in short-term clinical outcomes. (The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - PARTNER II - PARTNERII - S3 Intermediate [PARTNERII S3i]; NCT03222128; PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - High Risk and Nested Registry 7 [PII S3HR/NR7]; NCT03222141). Copyright (c) 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: Baseline, 30-day, and 1- and 2-year transthoracic echocardiograms from the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registry were analyzed by a consortium of core laboratories and divided into the American Society of Echocardiography DD groups. OBJECTIVES: The authors aimed to assess the association between diastolic dysfunction (DD) and outcomes in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). RESULTS: Among the 1,750 included, 682 (54.4%) had grade 1 DD, 352 (28.1%) had grade 2 DD, 168 (13.4%) had grade 3 DD, and 51 (4.1%) had indeterminate DD grade. Incremental baseline grades of DD were associated with an increase in combined 1- and 2-year cardiovascular (CV) death/rehospitalization (all p < 0.002) and all-cause death at 2 years (p = 0.01) but not at 1 year. Improvement in DD grade/grade 1 DD at 30 days post-TAVR was seen in 70.8% patients. Patients with improvement in >=1 grade of DD/grade 1 DD had reduced 1-year CV death/rehospitalization (p < 0.001) and increased 2-year survival (p = 0.01). Baseline grade 3 DD was a predictor of 1-year CV death/rehospitalization (hazard ratio: 2.73; 95% confidence interval: 1.07 to 6.98; p = 0.04). Improvement in DD grade/grade 1 DD at 30 days was protective for 1-year CV death/rehospitalizations (hazard ratio: 0.39; 95% confidence interval: 0.19 to 0.83; p = 0.01).
English
0735-1097
10.1016/j.jacc.2020.10.032 [doi] S0735-1097(20)37626-9 [pii]
*Aortic Valve Stenosis
*Heart Failure, Diastolic
*Patient Readmission/sn [Statistics & Numerical Data]
*Postoperative Complications
*Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
Aged, 80 and over
Aortic Valve Stenosis/mo [Mortality]
Aortic Valve Stenosis/pp [Physiopathology]
Aortic Valve Stenosis/su [Surgery]
Canada
Echocardiography/mt [Methods]
Echocardiography/sn [Statistics & Numerical Data]
Female
Heart Failure, Diastolic/di [Diagnosis]
Heart Failure, Diastolic/et [Etiology]
Heart Failure, Diastolic/pp [Physiopathology]
Humans
Male
Outcome and Process Assessment, Health Care
Postoperative Complications/di [Diagnosis]
Postoperative Complications/pp [Physiopathology]
Prognosis
Survival Analysis
Transcatheter Aortic Valve Replacement/mt [Methods]
United States
MedStar Heart & Vascular Institute
Journal Article
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: Few studies have evaluated if diastolic function could predict outcomes in patients with aortic stenosis. CONCLUSIONS: In the PARTNER 2 SAPIEN 3 registry, baseline DD was a predictor of up to 2 years clinical outcomes in patients who underwent TAVR. Improvement in DD grade at 30 days was associated with improvement in short-term clinical outcomes. (The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - PARTNER II - PARTNERII - S3 Intermediate [PARTNERII S3i]; NCT03222128; PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - High Risk and Nested Registry 7 [PII S3HR/NR7]; NCT03222141). Copyright (c) 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: Baseline, 30-day, and 1- and 2-year transthoracic echocardiograms from the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registry were analyzed by a consortium of core laboratories and divided into the American Society of Echocardiography DD groups. OBJECTIVES: The authors aimed to assess the association between diastolic dysfunction (DD) and outcomes in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). RESULTS: Among the 1,750 included, 682 (54.4%) had grade 1 DD, 352 (28.1%) had grade 2 DD, 168 (13.4%) had grade 3 DD, and 51 (4.1%) had indeterminate DD grade. Incremental baseline grades of DD were associated with an increase in combined 1- and 2-year cardiovascular (CV) death/rehospitalization (all p < 0.002) and all-cause death at 2 years (p = 0.01) but not at 1 year. Improvement in DD grade/grade 1 DD at 30 days post-TAVR was seen in 70.8% patients. Patients with improvement in >=1 grade of DD/grade 1 DD had reduced 1-year CV death/rehospitalization (p < 0.001) and increased 2-year survival (p = 0.01). Baseline grade 3 DD was a predictor of 1-year CV death/rehospitalization (hazard ratio: 2.73; 95% confidence interval: 1.07 to 6.98; p = 0.04). Improvement in DD grade/grade 1 DD at 30 days was protective for 1-year CV death/rehospitalizations (hazard ratio: 0.39; 95% confidence interval: 0.19 to 0.83; p = 0.01).
English
0735-1097
10.1016/j.jacc.2020.10.032 [doi] S0735-1097(20)37626-9 [pii]
*Aortic Valve Stenosis
*Heart Failure, Diastolic
*Patient Readmission/sn [Statistics & Numerical Data]
*Postoperative Complications
*Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
Aged, 80 and over
Aortic Valve Stenosis/mo [Mortality]
Aortic Valve Stenosis/pp [Physiopathology]
Aortic Valve Stenosis/su [Surgery]
Canada
Echocardiography/mt [Methods]
Echocardiography/sn [Statistics & Numerical Data]
Female
Heart Failure, Diastolic/di [Diagnosis]
Heart Failure, Diastolic/et [Etiology]
Heart Failure, Diastolic/pp [Physiopathology]
Humans
Male
Outcome and Process Assessment, Health Care
Postoperative Complications/di [Diagnosis]
Postoperative Complications/pp [Physiopathology]
Prognosis
Survival Analysis
Transcatheter Aortic Valve Replacement/mt [Methods]
United States
MedStar Heart & Vascular Institute
Journal Article