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Echocardiographic L-wave as a prognostic indicator in transcatheter aortic valve replacement

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Abstract

This study applies L-wave measurements of mid-diastolic trans-mitral flow. Although considered to be a marker of elevated filling pressure or delayed myocardial relaxation, its clinical and prognostic value is yet to be completely elucidated. It has been shown that transcatheter aortic valve replacement (TAVR) induces reverse remodeling and improves diastolic function and prognosis in patients with severe aortic stenosis (AS). Our purpose was to evaluate the prognostic value of L-wave following TAVR. We examined clinical and echocardiographic data of patients undergoing TAVR. L-Wave presence and velocity were recorded at baseline and at 1 month and 6 months following TAVR. The effect of the procedure on L-wave measurements and its impact on mortality and other clinical outcomes were analyzed. A total of 502 patients (mean age 82.58 ± 5.9) undergoing TAVR were included. Patients with baseline L-wave (n = 68, 12%) had a smaller stroke volume index by 5.7 ± 2.3 ml/m2 (p = 0.01) as compared to patients without L-wave at baseline. L-waves disappeared In 35% and 70% of patients at 1 month and at 6 months respectively. Baseline L-wave velocity was 34.8 ± 11.5 (cm/s) and decreased significantly at follow-up examinations. Patients with persistent L-wave following TAVR had higher 3-year adjusted mortality rates (HR 5.7, 95% CI 3.7–8.9, p < 0.001). Multivariate analysis of survival was also statistically significant (p < 0.001). TAVR induces L-wave disappearance and a decrease in L-wave velocity in patients with severe AS. L-wave persistence following TAVR is an independent risk factor for mortality.

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Acknowledgements

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Drs. Ilan Merdler and Aviram Hochstadt. The first draft of the manuscript was written by Drs. Ilan Merdler and Itamar Loewenstein and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel

    Ilan Merdler, Aviram Hochstadt, Itamar Loewenstein, Samuel Morgan, Tamar Itach, Yan Topilsky, Ariel Finkelstein, Michal Laufer-Perl, Shmuel Banai & Ben Sadeh

  2. Tel Aviv University Medical School, Tel-Aviv, Israel

    Eyal Richert

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  1. Ilan Merdler
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Correspondence to Ben Sadeh.

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The authors whose names are listed above certify that they have NO affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. All Authors have seen and approved the manuscript being submitted. We warrant that the article is the Authors' original work. We warrant that the article has not received prior publication and is not under consideration for publication elsewhere. On behalf of all Co-Authors, the corresponding Author shall bear full responsibility for the submission.

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Merdler, I., Richert, E., Hochstadt, A. et al. Echocardiographic L-wave as a prognostic indicator in transcatheter aortic valve replacement. Int J Cardiovasc Imaging 36, 1897–1905 (2020). https://doi.org/10.1007/s10554-020-01903-8

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