Key result
Atrial fibrillation is associated with less LVMI reduction one year post-TAVR versus sinus rhythm.
Why the study?
AF is associated with increased mortality after TAVR, and the study sought to determine whether impaired LV reverse remodeling represents an underlying mechanism.
Does atrial fibrillation impair left ventricular reverse remodeling in patients undergoing transcatheter aortic valve replacement?
Observational (n=213)
No
Does atrial fibrillation impair left ventricular reverse remodeling in patients undergoing transcatheter aortic valve replacement?
Atrial fibrillation is associated with impaired left ventricular reverse remodeling after TAVR, which correlates with worse long-term clinical outcomes including death or cardiac rehospitalization.
AF associated with attenuated LVMI regression post-TAVR; leaves open whether rhythm control improves remodeling.
AIMS: Atrial fibrillation (AF) is associated with increased mortality after transcatheter aortic valve replacement (TAVR). Cerebrovascular complications and bleeding events associated with anticoagulation therapy are discussed to be possible causes for this increased mortality. The present study sought to assess whether AF is associated with impaired left ventricular (LV) reverse remodeling representing another possible mechanism for poor outcome. METHODS: All patients who underwent TAVR in our institution and had 1-year echocardiography follow-up were included. LV mass index (LVMI) at baseline and follow-up as well as LVMI change at 1 year were assessed with respect to the presence of AF (either at baseline or during hospitalization after TAVR) and sinus rhythm (SR). RESULTS: ; p = 0.02) and they showed lower relative LVMI change at 1 year (- 2 ± 28% vs. - 9 ± 29%; p = 0.04). In linear regression analysis, AF was independently associated with relative LVMI change (regression coefficient ß 0.076 [95% CI 0.001-0.150]; p = 0.04). With respect to clinical outcome depending on AF and LVMI regression, the Kaplan-Meier estimated event-free of death or cardiac rehospitalization at 3 years was lowest among patients with AF and no LVMI regression. CONCLUSIONS: The present study identified a significant association of AF with changes in LVMI after TAVR, which was also shown to be associated with clinical outcome.
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Ledwoch et al. (2021) conducted an observational in Severe symptomatic aortic stenosis undergoing TAVR (n=213). Atrial fibrillation vs. Sinus rhythm was evaluated on Relative change in left ventricular mass index (LVMI) at 1 year (ß 0.076, 95% CI 0.001-0.150, p=0.04). Atrial fibrillation was independently associated with a lower relative reduction in left ventricular mass index at 1 year after TAVR compared to sinus rhythm (-2% vs -9%, p=0.04).
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