Long-Term Persistence of Diastolic Dysfunction and Dyspnea in Patients who Underwent Aortic Valve Replacement for Aortic Valve Stenosis
Author(s): Valentin Bridonneau, Elena Galli, Elise Paven, Kyriakos Yiangou, Jean-Philippe Verhoye, Christophe Leclercq, Guillaume Bouzille, Erwan Donal
Background: Aortic stenosis (AS) requires treatment when is severe and symptomatic. However, after the correction of the AS, some patients still remain symptomatic. Severe AS can lead after aortic valve replacement to heart failure with preserved ejection fraction (HFpEF). We sought to describe the clinical status and to characterized patients based on E/e’ at 1-year follow-up of patients operated for an AS according to current guidelines.
Method and Results: 236 patients were prospectively included before AVR (surgical or transcatheter) and followed-up at one year with a standardized clinical and echocardiographic evaluation. Among 191 patients evaluated at follow-up (FU), 82 (43%) remained symptomatic (NYHA ≥II). Persistence of dyspnea at 1-year FU was associated with more severe echocardiographic diastolic function indices. Diastolic dysfunction (DD) was still demonstrated in 120 (63%) patients at one year. Using E/e’ as a surrogate marker of DD and elevated filling pressures, it was possible to characterize determinants of its persistence (E/e' ≥ 14). Our model demonstrated that patients with severe pre-operative DD (baseline E/e' ratio >16 and mitral E wave velocity >111 cm/s) had persistent elevated LV filling pressures, as opposed to patients who underwent surgical valve replacement with a baseline E/e' ratio ≤ 16 who mostly normalized their LV filling pressure.
Conclusion: 43% of treated AS patients remain symptomatic. DD characterization according to current standards allowed to predict E/e’ at one-year post AVR.