Diastolic dysfunction and myocardial ischemia in TAVI patients

Abstract

Introduction. Severe aortic stenosis and ischemic coronary artery disease are frequently associated in elderly patients, adding complexity to interventional management. Diastolic dysfunction, a marker of myocardial impairment and elevated filling pressures, may influence prognosis after transcatheter aortic valve implantation (TAVI), particularly in the presence of concomitant coronary pathology. The aim of the study was to analyze the interaction between severe aortic valve stenosis, left ventricular diastolic dysfunction, and coronary ischemia in elderly patients with complex cardiovascular disease. Material and methods. This was a prospective analytical cohort study including 85 patients treated between 2019 and 2023, divided into two groups: Group I – TAVI without coronary intervention (n = 56), and Group II – TAVI associated with percutaneous coronary intervention (PCI) (n = 29), consisting of patients with significant coronary lesions. Echocardiography was performed according to the ESC/EACVI 2016 guideline standards, with detailed assessment of diastolic function. Results. The prevalence of left ventricular diastolic dysfunction of varying severity showed a statistically significant difference between groups (p = 0.04): Group I – 35 patients (62.5%) versus Group II – 24 patients (82.7%). The E-wave velocity was lower in Group II: 152.4 cm/sec (IQR = 43.0) compared to 173.0 cm/sec (IQR = 32.0), p = 0.01. The E/A ratio and the incidence of E/A ≥2 showed a borderline significant difference (p = 0.04). Median E/e′ was higher in Group II – 9.2 (IQR = 5.4) compared to 6.4 (IQR = 4.2), p = 0.003. E/Vp was 1.2 (IQR = 0.4) versus 0.8 (IQR = 0.5), p < 0.001. Diastolic dysfunction was more frequent in Group II, with significantly different echocardiographic parameters, including decreased E-wave velocity, increased E/e′ and E/Vp ratios, and a higher incidence of E/A ≥2. Conclusions. Patients undergoing both PCI and TAVI more frequently exhibited left ventricular diastolic dysfunction. The echocardiographic parameters E, E/e′, and E/Vp showed statistically significant differences, suggesting an additive impact of coronary artery disease on diastolic function impairment in the setting of severe aortic stenosis.