Does transcatheter aortic valve implantation improve left ventricular function, hemodynamics, and ventricular arrhythmias in patients with severe aortic stenosis?
TAVI significantly improves left ventricular function, promotes reverse remodeling, and reduces severe ventricular arrhythmias up to 1 year in patients with severe aortic stenosis.
To assess changes in LV function, hemodynamics, and ventricular arrhythmias (VAs) after transcatheter aortic valve implantation (TAVI) in severe aortic stenosis (AS) patients at 1-month and 1-year follow-up. Eighty severe AS patients undergoing TAVI were analyzed after exclusions (prior pacemaker, post-TAVI complications, death, or missing data). Echocardiography (left ventricular ejection fraction LVEF, left ventricular end-diastolic diameter LVEDD, mean transaortic gradient), NT-proBNP levels, and 24-h Holter monitoring (modified Lown grading for VAs) were evaluated pre-TAVI, at 1 month, and 1 year post-TAVI. At 1 month, LVEF improved from 41.5 ± 7.8% to 48.0 ± 6.0% (P = 0.034), LVEDD decreased from 56.6 ± 11.5 mm to 54.0 ± 11.0 mm (P = 0.020), and mean gradient dropped from 54.8 ± 9.5 mmHg to 18.2 ± 4.5 mmHg (P < 0.001). NT-proBNP decreased from 3870 pg/mL (IQR: 780–26500) to 1015 pg/mL (IQR: 550–8500) (P < 0.01). Lown grade 3–4 VAs declined from 33.8% to 17.5% (P = 0.030). At 1 year, LVEF further improved to 51.5 ± 5.5% (P < 0.001), LVEDD to 52.5 ± 10.8 mm (P < 0.01), and mean gradient to 15.5 ± 4.0 mmHg (P < 0.001). NT-proBNP remained low (850 pg/mL, IQR: 450–15500; P < 0.001), and Lown 3–4 VAs decreased to 12.5% (P < 0.001). Ventricular tachycardia incidence reduced from 12.5% pre-TAVI to 5.0% at 1 year (P = 0.016). TAVI significantly improves LV function, promotes reverse remodeling, and reduces severe VAs in severe AS patients, with sustained benefits at 1 year, highlighting its positive impact on cardiac structure, function, and arrhythmic burden.
An et al. (Wed,) studied this question.