Left-ventricular reverse remodeling after transcatheter aortic valve implantation in patients with low-flow low-gradient aortic stenosis.

OBJECTIVES: Left-ventricular reverse remodeling (LVRR) is associated with improved outcome in heart failure patients. Factors associated with and predictive for LVRR in low-flow low-gradient aortic stenosis (LFLG AS) patients after transcatheter aortic valve implantation (TAVI) and its impact on outcome were assessed.

METHODS: Pre- and post-procedural left-ventricular (LV) function and volume were investigated in 219 LFLG patients. LVRR was defined as an absolute increase of ≥ 10% in LVEF and reduction of ≥ 15% in LV end-systolic volume. The primary endpoint was the combination of all-cause mortality and rehospitalization for heart failure.

RESULTS: Mean LVEF was 35.0 ± 10.0% with a stroke volume index (SVI) of 25.9 ± 6.0ml/m and a LV end-systolic volume (LVESV) of 94.04 ± 46.0ml. At a median of 5.2 months (IQR 2.7 - 8.1months), 77.2 % (n=169) of the patients showed echocardiographic evidence of LVRR. A multivariable model revealed three independent factors for LVRR after TAVI: 1) SVI of < 25ml/m (HR 2.31, 95%CI 1.08 - 3.58; p < 0.01), 2) LVEF < 30% (HR 2.76, 95%CI 1.53 - 2.91; p < 0.01) and 3) valvulo-arterial impedance (Z) < 5mmHg/ml/m (HR 5.36, 95%CI 1.80 - 15.98; p < 0.01). Patients without evidence of LVRR showed significantly higher incidence of the one-year combined endpoint (32 (64.0%) vs. 75 (44.4%); p < 0.01).

CONCLUSIONS: The majority of patients with LFLG AS show LVRR after TAVI, which is associated with favorable outcome. An SVI of < 25ml/m, LVEF < 30% and Z < 5mmHg/ml/m represent predictors of LVRR.

Copyright © 2023 Hellenic Society of Cardiology. Published by Elsevier B.V. All rights reserved.

PMID: 37119968