Faculty Bibliography

BACKGROUND:Impaired relaxation filling pattern in the presence of preserved left ventricular ejection fraction is a common finding which is ascribed to early diastolic dysfunction. We thought to determine the distribution of various markers of systolic and diastolic dysfunction in these patients. METHODS:A total of 106 patients were included in this retrospective observational study. Diastolic dysfunction was defined using the American Society of Echocardiography recommendations ("50% rule"). The systolic dysfunction was evaluated by global longitudinal strain and circumferential strain. For further analysis, the patients were divided into the lower strain (lower tertile) and higher strain (upper tertiles) groups based on longitudinal strain. RESULTS:There were marked differences between the groups in essential echocardiographic parameters. Patients in the lower strain group were more likely to have definite diastolic dysfunction (23% vs 7%, P<.01) and less likely to have normal diastolic function (54% vs 80%, P<.01). They also showed lower circumferential strain (-21.2% vs -25.7%, P<.01). In multivariate analysis, left atrial enlargement (odds ratio (OR) 4.6, 95% confidence interval (CI) 1.2-17.1), left ventricular mass index (OR 1.03, 95% CI 1.0-1.1), left ventricular end-diastolic volume (OR 1.1, 95% CI 1.0-1.1), and E-wave deceleration time (OR 0.99, 95% CI 0.98-1.0) were independently associated with lower global longitudinal strain. CONCLUSIONS:Patients with impaired relaxation filling pattern in the presence of preserved left ventricular ejection fraction have a wide spectrum of left ventricular systolic and diastolic performance abnormalities. Isolated assessment of diastolic dysfunction may not fully characterize this group of patients.

Recent trials have highlighted the comparable mortality benefits and durability of the results for patients with severe aortic stenosis (AS) and high surgical risk managed with either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (AVR). Various national guidelines and international regulatory bodies have approved TAVR, thereby leading to potential wide usage and dissemination of this technique worldwide. Quality-of-life outcomes, in spite of being an important measure of success and acceptability of the procedure, have not been publicized as extensively. For high risk patients with severe AS, implementation of TAVR has resulted in comparable survival, but different and novel adverse events compared with AVR. We present an updated review focusing on the quality-of-life outcomes and issues with this new and important procedural approach.