Aortic valve replacement significantly reduced left ventricular mass by a standardized mean difference of 37.24 g compared to baseline in patients with aortic stenosis.
Meta-Analysis (n=11,751)
Does aortic valve replacement improve left ventricular remodeling parameters in patients with aortic stenosis?
Aortic valve replacement for aortic stenosis leads to significant reverse left ventricular remodeling, including reduced LV mass and improved ejection fraction, observable as early as 1 month post-procedure.
Effect estimate: SMD -37.24 g (95% CI -49.31 to -25.18)
p-value: p=<0.0001
Reverse left ventricular (LV) remodeling after aortic valve replacement (AVR), in patients with aortic stenosis, is well-documented as an important prognostic factor. With this systematic review and meta-analysis, we aimed to characterize the response of the unloaded LV after AVR. We searched on MEDLINE/PubMed and Web of Science for studies reporting echocardiographic findings before and at least 1 month after AVR for the treatment of aortic stenosis. In total, 1,836 studies were identified and 1,098 were screened for inclusion. The main factors of interest were structural and dynamic measures of the LV and aortic valve. We performed a random-effects meta-analysis to compute standardized mean differences (SMD) between follow-up and baseline values for each outcome. Twenty-seven studies met the eligibility criteria, yielding 11,751 patients. AVR resulted in reduced mean aortic gradient (SMD: −38.23 mmHg, 95% CI: −39.88 to −36.58 , I2=92% ), LV mass (SMD: −37.24 g, 95% CI: −49.31 to −25.18 , I2=96% ), end-diastolic LV diameter (SMD: −1.78 mm, 95% CI: −2.80 to −0.76 , I2=96% ), end-diastolic LV volume (SMD: −1.6 ml, 95% CI: −6.68 to 3.51, I2=91% ), increased effective aortic valve area (SMD: 1.10 cm 2 , 95% CI: 1.01 to 1.20, I2=98% ), and LV ejection fraction (SMD: 2.35%, 95% CI: 1.31 to 3.40%, I2=94.1% ). Our results characterize the extent to which reverse remodeling is expected to occur after AVR. Notably, in our study, reverse remodeling was documented as soon as 1 month after AVR.
Nunes et al. (Thu,) conducted a meta-analysis in Aortic stenosis (n=11,751). Aortic valve replacement (SAVR or TAVI) vs. Baseline (pre-procedure) was evaluated on Left ventricular mass (LVM) (SMD -37.24 g, 95% CI -49.31 to -25.18, p=<0.0001). Aortic valve replacement significantly reduced left ventricular mass by a standardized mean difference of 37.24 g compared to baseline in patients with aortic stenosis.