Key result
Transcatheter aortic valve replacement significantly improved left ventricular ejection fraction from 57.9% to 65.4% and reduced total myocardial volume at 1 year follow-up.
Why the study?
Cardiovascular magnetic resonance imaging enables comprehensive quantification of myocardial function and structure to assess myocardial remodeling processes in patients with severe aortic stenosis undergoing TAVR.
Does transcatheter aortic valve replacement improve myocardial function and structure in patients with severe symptomatic aortic stenosis?
Observational (n=40)
No
Does transcatheter aortic valve replacement improve myocardial function and structure in patients with severe symptomatic aortic stenosis?
Absolute Event Rate: 65.4% vs 57.9%
p-value: p=0.002
TAVR in patients with severe aortic stenosis leads to significant functional and structural reverse myocardial remodeling, including regression of diffuse myocardial fibrosis, which correlates with clinical recovery.
CMR-detected reverse remodeling post-TAVR may aid monitoring in severe AS; extends prior data with cellular/matrix volume quantification.
Since cardiovascular magnetic resonance (CMR) imaging allows comprehensive quantification of both myocardial function and structure we aimed to assess myocardial remodeling processes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). CMR imaging was performed in 40 patients with severe AS before and 1 year after TAVR. Image analyses comprised assessments of myocardial volumes, CMR-feature-tracking based atrial and ventricular strain, myocardial T1 mapping, extracellular volume fraction-based calculation of left ventricular (LV) cellular and matrix volumes, as well as ischemic and non-ischemic late gadolinium enhancement analyses. Moreover, biomarkers including NT-proBNP as well as functional and clinical status were documented. Myocardial function improved 1 year after TAVR: LV ejection fraction (57.9 ± 16.9% to 65.4 ± 14.5%, p = 0.002); LV global longitudinal (− 21.4 ± 8.0% to -25.0 ± 6.4%, p < 0.001) and circumferential strain (− 36.9 ± 14.3% to − 42.6 ± 11.8%, p = 0.001); left atrial reservoir (13.3 ± 6.3% to 17.8 ± 6.7%, p = 0.001), conduit (5.5 ± 3.2% to 8.4 ± 4.6%, p = 0.001) and boosterpump strain (8.2 ± 4.6% to 9.9 ± 4.2%, p = 0.027). This was paralleled by regression of total myocardial volume (90.3 ± 21.0 ml/m2 to 73.5 ± 17.0 ml/m2, p < 0.001) including cellular (55.2 ± 13.2 ml/m2 to 45.3 ± 11.1 ml/m2, p < 0.001) and matrix volumes (20.7 ± 6.1 ml/m2 to 18.8 ± 5.3 ml/m2, p = 0.036). These changes were paralleled by recovery from heart failure (decrease of NYHA class: p < 0.001; declining NT-proBNP levels: 2456 ± 3002 ng/L to 988 ± 1222 ng/L, p = 0.001). CMR imaging enables comprehensive detection of myocardial remodeling in patients undergoing TAVR. Regression of LV matrix volume as a surrogate for reversible diffuse myocardial fibrosis is accompanied by increase of myocardial function and recovery from heart failure. Further data are required to define the value of these parameters as therapeutic targets for optimized management of TAVR patients. Trial registration DRKS, DRKS00024479. Registered 10 December 2021—Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.
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Lange et al. (2022) conducted an observational in Severe symptomatic aortic stenosis (n=40). Transcatheter aortic valve replacement (TAVR) vs. Baseline (pre-TAVR) was evaluated on Left ventricular ejection fraction (p=0.002). Transcatheter aortic valve replacement significantly improved left ventricular ejection fraction from 57.9% to 65.4% and reduced total myocardial volume at 1 year follow-up.
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