A ≥36% reduction of left ventricular end-systolic volume index after TAVR was associated with a significantly lower risk of cardiac death or heart failure hospitalization (P=0.004).
Cohort (n=143)
Does a ≥36% reduction in LVESVi after TAVR improve the composite of cardiac death and heart failure hospitalization in patients with mixed aortic valve disease?
In patients with mixed aortic valve disease undergoing TAVR, significant cardiac reverse remodeling (≥36% reduction in LVESVi) at 1 year is associated with a lower risk of cardiac death and heart failure hospitalization.
p-value: p=0.004
Abstract Background Mixed aortic valve disease (MAVD), characterized by concurrent presence of aortic stenosis (AS) and aortic regurgitation (AR), exhibits distinct cardiac structural and functional characteristics compared to isolated aortic valve disease. The aim of the present study was to elucidate the impact of cardiac reverse remodeling after transcatheter aortic valve replacement (TAVR) on prognosis in MAVD. Methods The present study included patients with severe symptomatic AS and moderate or greater AR who underwent TAVR and both preoperative and one-year follow-up echocardiography. Reverse remodeling after TAVR was defined as the change of each left ventricular end-systolic volume index (LVESVi), end-diastolic volume index or mass index from baseline to one-year follow-up. The primary outcome was a composite of cardiac death and hospitalization due to heart failure. Results A total of 143 patients was enrolled (83.4 ± 6.0 years, 46.9% male). At baseline, average LV ejection fraction was 60 ± 12%, LV end-diactolic volume index was 67.0 ± 23.5 ml/m2, LVESVi was 27.5 ± 16.3 ml/m2, and LVMi was 135 ± 39 g/m2, aortic valve area index was 0.43 ± 0.12 cm/m2. Of all, 126 patients (88.1%) had moderate AR, and 17 patients (11.9%) severe AR. During a median follow-up period of 519 days (25th to 75th interquartile range: 313 to 973 days), 17 patients achieved the primary outcome. Decrease of LVESVi with a cut-off value of 36% was optimal at identifying favorable prognosis (AUC: 0.65, sensitivity: 35%, specificity:100%, P = 0.045). Patients with ≥36% reduction of LVESVi after TAVR had significantly better prognosis than those without it (P = 0.004, Figure). Preoperative larger LVESVi and higher LV mass index were predictors of ≥36% decrease of LVESVi following TAVR. Conclusions Greater decrease of LVESVi following TAVR was associated with improved postoperative prognosis in MAVD. Patients with more advanced preoperative cardiac remodeling exhibited greater postoperative reverse remodeling.
Saijo et al. (Sat,) conducted a cohort in Mixed aortic valve disease (severe aortic stenosis and moderate or greater aortic regurgitation) (n=143). ≥36% reduction of left ventricular end-systolic volume index (LVESVi) after TAVR vs. <36% reduction of LVESVi after TAVR was evaluated on Composite of cardiac death and hospitalization due to heart failure (p=0.004). A ≥36% reduction of left ventricular end-systolic volume index after TAVR was associated with a significantly lower risk of cardiac death or heart failure hospitalization (P=0.004).