Left-ventricular reverse remodeling after TAVI in low-flow low-gradient aortic stenosis was associated with lower 1-year mortality or heart failure rehospitalization (44.4% vs 64.0%; p<0.01).
Observational (n=219)
Does transcatheter aortic valve implantation improve left-ventricular reverse remodeling and clinical outcomes in patients with low-flow low-gradient aortic stenosis?
In patients with low-flow low-gradient aortic stenosis undergoing TAVI, left ventricular reverse remodeling occurs in the majority of patients and is associated with a lower incidence of mortality and heart failure rehospitalization.
Absolute Event Rate: 44.4% vs 64%
p-value: p=< 0.01
Left-ventricular reverse remodeling (LVRR) is associated with improved outcome in heart failure patients. Factors associated with and predictive for LVRR in low-flow low-gradient aortic stenosis (LFLG AS) patients after transcatheter aortic valve implantation (TAVI) and its impact on outcome were assessed. Pre- and post-procedural left-ventricular (LV) function and volume were investigated in 219 LFLG patients. LVRR was defined as an absolute increase of ≥ 10% in LVEF and reduction of ≥ 15% in LV end-systolic volume. The primary endpoint was the combination of all-cause mortality and rehospitalization for heart failure. Mean LVEF was 35.0 ± 10.0% with a stroke volume index (SVI) of 25.9 ± 6.0ml/m2 and a LV end-systolic volume (LVESV) of 94.04 ± 46.0ml. At a median of 5.2 months (IQR 2.7 – 8.1months), 77.2 % (n=169) of the patients showed echocardiographic evidence of LVRR. A multivariable model revealed three independent factors for LVRR after TAVI: 1) SVI of < 25ml/m2 (HR 2.31, 95%CI 1.08 – 3.58; p < 0.01), 2) LVEF < 30% (HR 2.76, 95%CI 1.53 – 2.91; p < 0.01) and 3) valvulo-arterial impedance (Zva) < 5mmHg/ml/m2 (HR 5.36, 95%CI 1.80 – 15.98; p < 0.01). Patients without evidence of LVRR showed significantly higher incidence of the one-year combined endpoint (32 (64.0%) vs. 75 (44.4%); p < 0.01). The majority of patients with LFLG AS show LVRR after TAVI, which is associated with favorable outcome. An SVI of < 25ml/m2, LVEF < 30% and Zva < 5mmHg/ml/m2 represent predictors of LVRR.
Wilde et al. (Thu,) conducted a observational in Low-flow low-gradient aortic stenosis (n=219). Left-ventricular reverse remodeling (LVRR) after TAVI vs. No LVRR after TAVI was evaluated on Combination of all-cause mortality and rehospitalization for heart failure (p=< 0.01). Left-ventricular reverse remodeling after TAVI in low-flow low-gradient aortic stenosis was associated with lower 1-year mortality or heart failure rehospitalization (44.4% vs 64.0%; p<0.01).