Prognostic Relevance of Left Ventricular Myocardial Performance After Transcatheter Aortic Valve Replacement

Abstract

Background: The left-ventricular myocardial performance index Tei is an echocardiographic parameter that incorporates the information of systolic and diastolic time intervals. While the prognostic value of selected systolic and diastolic parameters is well established after transcatheter aortic valve replacement, the role of Tei has not been evaluated in this setting.

Methods and results: Between August 2007 and December 2015, consecutive patients with symptomatic, severe aortic stenosis and transthoracic echocardiography pre- and post-transcatheter aortic valve replacement were considered eligible for this analysis. The primary end point was all-cause mortality at 1 year after transcatheter aortic valve replacement. Of 824 patients with echocardiographic images to calculate Tei, pre-Tei was normal (<0.45) in 639 and high (≥0.45) in 185, whereas post-Tei was normal in 602 and high in 120, respectively. After adjustment for confounding factors, high pre-Tei was associated with an increased risk of all-cause mortality at 30 days (adjusted hazard ratio [HR_adj] 3.62; 95% CI, 1.89-6.91) and 1 year (HR_adj 2.56; 95% CI, 1.78-3.69). Similarly, post-Tei was associated with an increased risk of mortality between 30 days and 1-year follow-up (HR_adj 6.70; 95% CI, 4.22-10.63). At multivariable analysis Tei emerged as an independent predictor of early (pre-Tei index per 0.1-HR_adj 1.40; 95% CI, 1.23-1.60) and late mortality (post-Tei index per 0.1-HR_adj 1.40; 95% CI, 1.31-1.50), respectively.

Conclusions: The left-ventricular myocardial performance index Tei is associated with impaired clinical outcomes during short- and longer-term follow-up after transcatheter aortic valve replacement.

Clinical trial registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01368250.

Keywords: aortic valve stenosis; echocardiography; human; prognosis; transcatheter aortic valve replacement.