Abstract
Left ventricular reverse remodeling (LVRR) is associated with improved outcome in patients with heart failure. Factors associated with and predictive of LVRR in patients with low-flow low-gradient aortic stenosis (LFLG AS) after transcatheter aortic valve implantation (TAVI) and its impact on outcome were assessed. Pre- and postprocedural left ventricular (LV) function and volume were investigated in 219 patients with LFLG. LVRR was defined as an absolute increase of ≥10% in LV ejection fraction (LVEF) and reduction of ≥15% in LV end-systolic volume (LVESV). The primary endpoint was the combination of all-cause mortality and rehospitalization for heart failure. The mean LVEF was 35.0±10.0%, with a stroke volume index (SVI) of 25.9±6.0mL/m2 and LVESV of 94.04±46.0mL. At a median of 5.2months (interquartile range, 2.7-8.1months), 77.2% (n=169) of the patients showed echocardiographic evidence of LVRR. A multivariate model revealed three independent factors for LVRR after TAVI: SVI of <25mL/m2 (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.08-3.58; p<0.01), LVEF of <30% (HR, 2.76; 95% CI, 1.53-2.91; p<0.01), and valvulo-arterial impedance (Zva) of <5mmHg/mL/m2 (HR, 5.36; 95% CI, 1.80-15.98; p<0.01). Patients without evidence of LVRR showed a significantly higher incidence of the 1-year combined endpoint (32 [64.0%] vs. 75 [44.4%], p<0.01). The majority of patients with LFLG AS show LVRR after TAVI, which is associated with favorable outcomes. An SVI of <25mL/m2, LVEF of <30%, and Zva < 5mmHg/mL/m2 represent predictors of LVRR.
Published Version
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