Key result
Classical low-flow low-gradient AS shows superior post-TAVI LV reverse remodeling compared with high-gradient disease.
Why the study?
Do changes in cardiac structure and function after TAVI differ according to baseline flow and gradient patterns in patients with severe aortic stenosis?
Cohort (n=4,523)
Yes
Do changes in cardiac structure and function after TAVI differ according to baseline flow and gradient patterns in patients with severe aortic stenosis?
Effect estimate: ~1.5-fold higher
Cardiac reverse remodeling after TAVI differs significantly by baseline flow-gradient pattern, with classical low-flow low-gradient AS showing greater improvements in LVEF and dimensions compared to high-gradient AS, while paradoxical low-flow low-gradient AS shows less improvement.
Aims In patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS), data on the differences in subsequent cardiac structure and function among stratified groups with flow gradient patterns through the aortic valve are insufficient. Methods and results In this large multicenter study, 4523 patients undergoing TAVI for severe AS between 2013 and 2019 were divided into three groups according to the following criteria: (i) high-gradient AS (HG-AS) [mean pressure gradient (MPG) ≥ 40 mmHg], (ii) classical low-flow low-gradient AS (cLFLG-AS) [MPG < 40 mmHg, left ventricular (LV) ejection fraction (LVEF) <50%], and (iii) paradoxical low-flow low-gradient AS (pLFLG-AS) [MPG < 40 mmHg, LVEF ≥ 50% but stroke volume index (SVi) <35 mL/m2]. Echocardiography was performed at baseline, post-procedure, and 1 year post-TAVI. 3697, 507, and 319 patients had HG-AS, cLFLG-AS, and pLFLG-AS, respectively. After adjusting for clinical factors, cLFLG-AS and pLFLG-AS had an ∼1.5-fold higher 2-year all-cause mortality compared with HG-AS. During 1 year following TAVI, compared with HG-AS, cLFLG-AS showed greater reduction of LV systolic diameter (LVDs) and LV diastolic diameter (LVDd) and greater increase of LVEF (P < 0.001 for all), and changes in LV mass index (LVMi) and SVi were comparable (P = 0.915 and P = 0.821, respectively). However, pLFLG-AS demonstrated less reduction of LVDs and LVDd (P = 0.039 and P = 0.001, respectively), less improvement of LVEF and LVMi (P = 0.045 and P < 0.001, respectively), and comparable change in SVi (P = 0.364). Conclusion During 1 year post-TAVI, compared with HG-AS, cLFLG-AS achieves smaller LV diameters, greater increase in LVEF, and comparable regression of LVMi, whereas pLFLG-AS does not.
No takes yet. Share an insight, caveat, or question.
Yokoyama et al. (2024) conducted a cohort in Severe aortic stenosis (n=4,523). Low-flow low-gradient aortic stenosis (classical and paradoxical) vs. High-gradient aortic stenosis (HG-AS) was evaluated on 2-year all-cause mortality (~1.5-fold higher). Following TAVI, classical low-flow low-gradient AS achieved greater LVEF increase and LV diameter reduction than high-gradient AS (P<0.001), whereas paradoxical low-flow low-gradient AS did not.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: