Author + information
- Masahiko Asami1,
- Thomas Pilgrim2,
- Jonas Lanz3,
- Dik Heg4,
- Raffaele Piccolo1,
- Bettina Langhammer5,
- Fabien Praz6,
- Marco Valgimigli7,
- Eva Roost5,
- Stephan Windecker8 and
- Stefan Stortecky8
- 1Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
- 2Bern University Hospital, Berne, Switzerland
- 3Inselspital Bern, Bern, Switzerland
- 4Clinical Trials Unit, Department of Clinical Research, Institute of Social and, Bern, Switzerland
- 5Department of Cardiac Surgery, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
- 6Columbia University Medical Center, New York City, New York, United States
- 7Swiss Cardiovascular Center, Inselpsital, Bern, Switzerland
- 8University Hospital Bern, Bern, Switzerland
The left-ventricular myocardial performance index TEI is an echocardiographic parameter that incorporates the information of systolic and diastolic time intervals. Although the prognostic value of selected systolic and diastolic parameters is well established after transcatheter aortic valve replacement (TAVR), the role of TEI has not been evaluated in this setting, yet. Therefore, the aim of this study was to assess the impact of left-ventricular TEI index on short- and longer-term outcomes after TAVR.
Between August 2007 and December 2015, consecutive patients with symptomatic, severe aortic stenosis and transthoracic echocardiography pre and post TAVR were considered eligible for this analysis. Prospective follow-up was scheduled at 30days and 12months. Major adverse events were adjudicated according to the VARC-2 standardized endpoint definitions by an independent clinical event committee.
Of 895 patients with echocardiographic images to calculate TEI, 687 had normal (<0.45) and 208 had high TEI (≥0.45) at baseline prior to TAVR (pre-TEI), whereas 644 and 139 presented normal and high TEI after TAVR (post-TEI), 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, HRadj 3.92, 95%CI 2.09–7.33) and 12 months (HRadj 2.91, 95%CI 2.07–4.10). At multivariable analysis pre-TEI emerged as an independent predictor of early (per 0.1-HRadj 1.33, 95%CI 1.21–1.46) and late mortality (per 0.1-HRadj 1.59, 95%CI 1.43–1.77). Similarly, post-TEI was associated with an increased risk of mortality between 30 days and 12 months (HRadj 6.27, 95%CI 4.05–9.70) and was identified as independent predictor of mortality (per 0.1–HRadj 1.41, 95%CI 1.33–1.50).
The left-ventricular myocardial performance index TEI is a reference parameter for global systolic and diastolic LV function and was associated with clinical outcomes during short and longer-term follow-up after TAVR.
STRUCTURAL: Valvular Disease: Aortic