Key result
Transcatheter aortic valve implantation was associated with a significant improvement in left ventricular ejection fraction through 1 year (increase of 12.3 percentage points; p < 0.001).
Why the study?
LVEF recovery after TAVI varies among patients with severe aortic stenosis and reduced LVEF, and its associations with IHD and baseline LV end-diastolic diameter are not well characterized.
Does transcatheter aortic valve implantation improve left ventricular ejection fraction in patients with severe aortic stenosis and reduced LVEF, and how do ischemic heart disease and baseline left ventricular end-diastolic diameter affect this recovery?
Cohort (n=121)
Does transcatheter aortic valve implantation improve left ventricular ejection fraction in patients with severe aortic stenosis and reduced LVEF, and how do ischemic heart disease and baseline left ventricular end-diastolic diameter affect this recovery?
TAVI leads to significant LVEF improvement and reverse remodeling at 1 year in patients with severe aortic stenosis and reduced LVEF, though recovery is blunted by concurrent ischemic heart disease and larger baseline LV dimensions.
TAVI-associated LVEF gains in low-EF severe AS should not yet change practice; leaves open ischemic disease and baseline LV dimensions as recovery modifiers.
PURPOSE: Left ventricular ejection fraction (LVEF) recovery after transcatheter aortic valve implantation (TAVI) varies among patients with severe aortic stenosis and reduced LVEF. We characterized serial changes in LVEF and examined their associations with ischemic heart disease (IHD) and baseline left ventricular end-diastolic diameter. METHODS: Among 685 patients who underwent TAVI between 2014 and 2024, 121 with native-valve severe aortic stenosis and baseline LVEF < 50% were analyzed. Echocardiography was performed before TAVI, early after TAVI (median, 3 days), and at 1, 6, and 12 months. Serial LVEF recovery was evaluated using linear mixed-effects models incorporating all available post-TAVI measurements. RESULTS: LVEF improved significantly through 1 year, with a model-estimated increase of 12.3 percentage points (p < 0.001); left ventricular end-diastolic diameter, end-systolic diameter, and mass index also decreased. In multivariable mixed-effects models, IHD, baseline LVEF, baseline left ventricular end-diastolic diameter, and baseline mean aortic valve pressure gradient were associated with serial LVEF recovery. Adjusted recovery was greatest in patients without IHD and with smaller left ventricular end-diastolic diameter and most limited in those with IHD and larger left ventricular end-diastolic diameter. CONCLUSION: TAVI was associated with serial LVEF improvement and left ventricular reverse remodeling. IHD and larger baseline left ventricular end-diastolic diameter were associated with limited LVEF recovery.
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Tanaka et al. (2026) conducted a cohort in Severe aortic stenosis with reduced LVEF (n=121). Transcatheter aortic valve implantation (TAVI) was evaluated on Serial LVEF recovery (increase of 12.3 percentage points, p=< 0.001). Transcatheter aortic valve implantation was associated with a significant improvement in left ventricular ejection fraction through 1 year (increase of 12.3 percentage points; p < 0.001).
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