Left ventricular stiffness predicts outcome in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

Objectives Assessment of the prognostic role of left ventricular stiffness ( LVS ) in patients with aortic stenosis ( AS ) undergoing transcatheter aortic valve implantation ( TAVI ). Methods We performed a complete two‐dimensional transthoracic echocardiographic study before and after TAVI in patients with severe AS at high surgical risk. In order to assess LVS , we measured LV end‐diastolic pressure ( EDP ) invasively during TAVI and LV end‐diastolic volume ( EDV ) by means of echocardiography. We defined LVS as the EDV indexed by body surface area at an EDP of 20 mm Hg ( EDVI 20 ). Our aim was to assess the impact of LVS on one‐year all‐cause mortality after TAVI . Results One hundred sixty‐six patients undergoing TAVI (64% female; mean age 82.7 ± 5.1 years) were enrolled. Seven patients died within the first 30 days after TAVI and 21 within 1 year. Overall follow‐up duration was 580 ± 478 days. At multivariate analysis, independent predictors of 1‐year all‐cause mortality were moderate‐to‐severe paravalvular leak ( PVL ; HR 4.7, 95% confidence interval [ CI ] 1.9‐11, P= .0003), female gender ( HR 3.5, 95% CI 1.0‐12, P =.045), and EDVI 20 ( HR 0.94, 95% CI 0.90‐0.98, P= .015). In particular, patients with higher LVS ( EDVI 20 ≤48 mL/m 2 ) had a 1‐year mortality of 26.9% vs 7.4% in patients with lower LVS ( EDVI 20 >48 mL/m 2 ; HR 4.2, 95% CI 1.6‐10.6, P= .0007). Patients with higher LVS who developed moderate‐to‐severe PVL had the worst outcome (incremental chi‐square test, P= .014). Conclusion In patients with AS , an increased LVS has a negative prognostic impact. Development of significant PVL in patients with higher LVS had an incremental adverse effect.