Early Enhancement of Mitral Annular e' Following Transcatheter Aortic Valve Implantation: The Role of Early Diastolic Filling.

PURPOSE: Early improvements in left ventricular (LV) diastolic function have been documented following transcatheter aortic valve implantation (TAVI), but it remains unclear whether the increase in early diastolic mitral annular velocity (e') reflects intrinsic improvement in LV relaxation or altered hemodynamic conditions. This study investigated early changes in e' after TAVI, with a particular focus on the hemodynamic determinants of the increase in e'.

METHODS

A retrospective analysis was conducted in 129 consecutive patients with severe aortic stenosis who underwent successful TAVI and echocardiographic evaluation before and within one week after the procedure. Clinical and echocardiographic parameters were compared before and after TAVI, and factors associated with changes in e' were evaluated.

RESULTS

TAVI significantly increased septal, lateral, and mean e', transmitral early diastolic (E) velocity, and LV ejection fraction (LVEF) while reducing the transvalvular pressure gradient. In multivariate linear regression analysis, with changes in LVEF, E velocity, mean transvalvular pressure gradient, stroke volume, baseline mean e', and atrial fibrillation entered as covariates, baseline mean e' (β = -0.590, p < 0.001), atrial fibrillation (β = 0.523, p = 0.006), and changes in E velocity (β = 0.019, p = 0.018) were independently associated with changes in mean e'.

CONCLUSION

e' increased rapidly after TAVI. Changes in E velocity were independently associated with changes in mean e', even after adjustment for changes in stroke volume, suggesting that early changes in e' reflect not only intrinsic improvement in LV relaxation but also load-related mechanisms during early diastolic filling.