Key result
Greater LVMI regression post-TAVR is linked to ~5% lower 5-year mortality per 10% decrease.
Why the study?
The association between left ventricular mass index regression and longer-term post-TAVR clinical outcomes remained unclear.
Cohort (n=1,434)
Yes
Hazard Ratio: 0.95 (95% CI 0.91–0.98)
p-value: p=0.004
Clinical evaluation reveals left ventricular mass regression following transcatheter aortic valve replacement, indicating favorable reverse cardiac remodeling.
BACKGROUND Greater early left ventricular mass index (LVMi) regression is associated with fewer hospitalizations 1 year after transcatheter aortic valve replacement (TAVR). The association between LVMi regression and longer-term post-TAVR outcomes is unclear. OBJECTIVES The purpose of this study was to determine the association between LVMi regression at 1-year post-TAVR and clinical outcomes between 1 and 5 years. METHODS Among intermediate- and high-risk patients who received TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) I, II, and S3 trials or registries and were alive at 1 year, we included patients with baseline moderate or severe left ventricular hypertrophy (LVH) and paired measurements of LVMi at baseline and 1 year. The associations between LVMi regression (percent change between baseline and 1 year) and death or rehospitalization from 1 to 5 years were examined. RESULTS Among 1,434 patients, LVMi was 146 g/m2 (interquartile range [IQR]: 133 to 168 g/m2) at baseline and decreased 14.5% (IQR: 4.2% to 26.1%) to 126 g/m2 (IQR: 106 to 148 g/m2) at 1 year. After adjustment, greater LVMi regression at 1 year was associated with lower all-cause death (adjusted hazard ratio [aHR]: 0.95 per 10% decrease in LVMi; 95% confidence interval [CI]: 0.91 to 0.98; p = 0.004; aHR of the quartile with greatest vs. least LVMi regression: 0.61; 95% CI: 0.43 to 0.86; p = 0.005). Severe LVH at 1 year was observed in 39%, which was independently associated with increased all-cause death (aHR of severe LVH vs. no LVH: 1.71; 95% CI: 1.20 to 2.44; p = 0.003). Similar associations were found for rates of cardiovascular mortality and rehospitalization. CONCLUSIONS Among patients with moderate or severe LVH treated with TAVR who are alive at 1 year, greater LVMi regression at 1 year is associated with lower death and hospitalization rates to 5 years. These findings may have implications for the timing of valve replacement and the role of adjunctive medical therapy after TAVR.
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Chau et al. (2020) conducted a cohort in Moderate or severe left ventricular hypertrophy post-TAVR (n=1,434). LVMi regression at 1 year vs. Lesser LVMi regression was evaluated on all-cause death (HR 0.95, 95% CI 0.91-0.98, p=0.004). Greater left ventricular mass index regression at 1 year post-TAVR was associated with lower all-cause mortality up to 5 years (aHR 0.95 per 10% decrease; 95% CI 0.91-0.98; p=0.004).
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