Prognostic value of change in left ventricular ejection fraction and left atrial volume index after transcatheter aortic valve implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) is widely recognized for improving clinical outcomes in patients with severe aortic stenosis (AS). Although TAVI is known to improve cardiac function, the prognostic significance of subsequent echocardiographic changes remains uncertain. Purpose We aim to investigate which mid-term echocardiographic parameter improvements are associated with long-term clinical outcomes in patients with severe AS after TAVI. Methods In this single-center, retrospective registry study, 481 consecutive patients diagnosed with severe AS who underwent TAVI between February 2017 and November 2023 were evaluated. Transthoracic echocardiography was performed before the procedure and at a 6-month follow-up to assess systolic and diastolic parameters. The parameters, including the left ventricular ejection fraction (LVEF), left ventricular mass index (LVMi), left atrial volume index (LAVi), the ratio of early mitral inflow velocity to early diastolic mitral annular velocity (E/e’), and the tricuspid regurgitation peak gradient (TRPG), were measured. The primary endpoint was defined as a composite of cardiovascular death and heart failure hospitalization occurring within up to 3 years post-TAVI. Results At 6-month follow-up, most of the echocardiographic parameters significantly improved. Over a median follow-up of 565 days, the primary endpoint was observed in 37 (7.7%) patients. In multivariable analysis, changes in LVEF (ΔLVEF) and change in LAVi (ΔLAVi) were independently associated with the primary endpoint (ΔLVEF: OR 0.92 95% CI: 0.87–0.98, p=0.009; ΔLAVi: OR 1.04 95% CI: 1.01–1.07, p=0.008). To further clarify the prognostic impact of these 2 parameters, patients were stratified into 4 groups based on the presence or absence of improvement in LVEF and LAVi: both-improved, LVEF-improved, LAVi-improved, and non-improved. Notably, patients in the non-improved group exhibited significantly worse clinical outcomes compared with the other 3 groups (log-rank p=0.001, Figure). Conclusions A lack of improvement in both LVEF and LAVi at 6 months post-TAVI may serve as a marker for poorer prognosis. This finding suggests that echocardiography at mid-term follow-up could help identify patients at higher risk of adverse cardiovascular events, possibly enabling tailored post-TAVI management strategies.