TY - JOUR
T1 - Prognostic implications of residual left ventricular hypertrophy and systolic dysfunction in aortic stenosis following transcatheter aortic valve replacement
AU - Pedersen, Anders Lehmann Dahl
AU - Povlsen, Jonas Agerlund
AU - Rasmussen, Vibeke Guldbrand
AU - Frederiksen, Christian Alcaraz
AU - Christiansen, Evald Høj
AU - Terkelsen, Christian Juhl
AU - Vase, Henrik
AU - Poulsen, Steen Hvitfeldt
N1 - © 2022. The Author(s), under exclusive licence to Springer Nature B.V.
PY - 2023/1
Y1 - 2023/1
N2 - The impact of left ventricle (LV) hypertrophy (LVH) regression on contractility-associated measures, the extent of residual cardiac dysfunction and prognostic implications after the initial remodeling process after transcatheter aortic valve replacement (TAVR) has not been investigated. We aimed to assess whether greater LV mass regression from pre-TAVR to 12-months after TAVR was associated with increased systolic function; and assess the prognostic value of residual LVH, systolic function and contractility-associated measures 12-months after TAVR. A total of 439 symptomatic patients were included and examined by echocardiography. LVH regression was assessed as percentage change in LV mass index (LVMi) from baseline to 12-months after TAVR. Midwall fractional shortening (mFS) and stress-corrected (SC-mFS) were used as contractility-associated measures. Primary outcome was all-cause mortality. SC-mFS increased from 0.94 (0.7) at baseline (BS) to 1.22 (0.7) (p < 0.05) 12-months after TAVR for patients with the most LVH regression, compared to patients with no LV regression (BS 1.06 (0.7) to 1.04 (0.5), NS). At 12-months after TAVR, multivariate analysis showed independent prognostic value of LVEF < 50% or GLS < 15% (HR 1.59, p = 0.049) and mFS < 14% (HR 1.99, p = 0.002) for future all cause death. LVH regression in AS after TAVR is associated with significant improvements of LV systolic function in contrast to patients without LV regression. Residual LVH and subsequent LV systolic dysfunction is substantial 12 months after TAVR and are associated with reduced survival. Impaired mFS and the combination of abnormal LVEF or GLS independently predicted all-cause mortality beyond 12 months after TAVR.
AB - The impact of left ventricle (LV) hypertrophy (LVH) regression on contractility-associated measures, the extent of residual cardiac dysfunction and prognostic implications after the initial remodeling process after transcatheter aortic valve replacement (TAVR) has not been investigated. We aimed to assess whether greater LV mass regression from pre-TAVR to 12-months after TAVR was associated with increased systolic function; and assess the prognostic value of residual LVH, systolic function and contractility-associated measures 12-months after TAVR. A total of 439 symptomatic patients were included and examined by echocardiography. LVH regression was assessed as percentage change in LV mass index (LVMi) from baseline to 12-months after TAVR. Midwall fractional shortening (mFS) and stress-corrected (SC-mFS) were used as contractility-associated measures. Primary outcome was all-cause mortality. SC-mFS increased from 0.94 (0.7) at baseline (BS) to 1.22 (0.7) (p < 0.05) 12-months after TAVR for patients with the most LVH regression, compared to patients with no LV regression (BS 1.06 (0.7) to 1.04 (0.5), NS). At 12-months after TAVR, multivariate analysis showed independent prognostic value of LVEF < 50% or GLS < 15% (HR 1.59, p = 0.049) and mFS < 14% (HR 1.99, p = 0.002) for future all cause death. LVH regression in AS after TAVR is associated with significant improvements of LV systolic function in contrast to patients without LV regression. Residual LVH and subsequent LV systolic dysfunction is substantial 12 months after TAVR and are associated with reduced survival. Impaired mFS and the combination of abnormal LVEF or GLS independently predicted all-cause mortality beyond 12 months after TAVR.
KW - Aortic stenosis
KW - Contractility
KW - Echocardiography
KW - Transcatheter aortic valve replacement
KW - Severity of Illness Index
KW - Predictive Value of Tests
KW - Prognosis
KW - Ventricular Function, Left
KW - Humans
KW - Transcatheter Aortic Valve Replacement/adverse effects
KW - Treatment Outcome
KW - Hypertrophy, Left Ventricular/diagnostic imaging
KW - Aortic Valve Stenosis/diagnostic imaging
KW - Aortic Valve/diagnostic imaging
UR - http://www.scopus.com/inward/record.url?scp=85134532772&partnerID=8YFLogxK
U2 - 10.1007/s10554-022-02688-8
DO - 10.1007/s10554-022-02688-8
M3 - Journal article
C2 - 36598683
AN - SCOPUS:85134532772
SN - 1569-5794
VL - 39
SP - 13
EP - 22
JO - International Journal of Cardiovascular Imaging
JF - International Journal of Cardiovascular Imaging
IS - 1
ER -