Impact of Right Heart Damage on the Prognostic Value of LV Mass Regression After TAVR

Left ventricular mass index (LVMI) regression after aortic valve replacement is associated with myocardial recovery and improved outcomes, but its prognostic relevance in advanced cardiac damage, particularly right heart involvement, is uncertain. The authors aimed to determine whether the prognostic relevance of LVMI regression after transcatheter aortic valve replacement (TAVR) differs according to right heart damage. We retrospectively analyzed data from 548 patients with severe aortic stenosis who underwent TAVR between 2011 and 2023. Extravalvular cardiac damage was staged by echocardiography as stages 0 to 2 (no right heart damage) or stages 3 to 4 (right heart damage). LVMI regression was defined as a reduction from baseline to 1 month after TAVR. The primary composite endpoint was cardiovascular death or heart failure hospitalization. Among the cohort (median age 81.0 [77.0-85.0] years; 51.3% women [281/548]), 9.1% (50/548) exhibited right heart damage. LVMI decreased after TAVR in both groups. Over a median follow-up of 1,020 (Q1-Q3: 552-1,731) days, LVMI regression was associated with lower risk of the primary endpoint in patients without right heart damage (adjusted HR: 0.59; 95% CI: 0.36-0.97; P = 0.04), whereas no association was observed in those with right heart damage (adjusted HR: 1.58; 95% CI: 0.40-6.27; P = 0.51) (P for interaction = 0.47). Although LVMI regression occurred after TAVR regardless of right heart involvement, an association with improved clinical outcomes was observed in patients without right heart damage but not in those with right heart damage; however, given the nonsignificant interaction test, this finding should be considered hypothesis-generating.