Diastolic Function and Clinical Outcomes After TAVR: PARTNER 2 SAPIEN 3 Registry
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This study used data from 1750 patients with aortic stenosis from the PARTNER 2 SAPEIN 3 registry to evaluate the relationship between diastolic dysfunction (DD) and clinical outcomes following transcatheter aortic valve replacement (TAVR). Echocardiography was used to divide patients into DD categories based on the American Society of Echocardiography guidelines, and all participants underwent transthoracic echocardiography at baseline, 30 days, 1 year, and 2 years. Just over half (54.4%) of participants were classified in DD grade 1, with 28.1% and 13.4% in grades 2 and 3, respectively. Additionally, 4.1% of participants were classified as having an indeterminate DD grade. Patients were followed for a median of 746.5 days. There were significant associations between incremental baseline grades of DD and both all-cause death at 2 years (but not at 1 year) and a combined measure of 1- and 2-year cardiovascular death and rehospitalization.
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Based on these data, baseline DD and 30-day improvements in DD may be useful in risk stratification of patients undergoing TAVR for aortic stenosis.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Few studies have evaluated if diastolic function could predict outcomes in patients with aortic stenosis.
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).
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.
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).
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).
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Additional Info
Diastolic Function and Clinical Outcomes After Transcatheter Aortic Valve Replacement: PARTNER 2 SAPIEN 3 Registry
J Am Coll Cardiol 2020 Dec 22;76(25)2940-2951, G Ong, P Pibarot, B Redfors, NJ Weissman, WA Jaber, RR Makkar, S Lerakis, D Gopal, O Khalique, SK Kodali, VH Thourani, S Anwaruddin, T McAndrew, Y Zhang, MC Alu, PS Douglas, RT HahnFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.