P932Structural changes in left ventricle after transcatheter aortic valve implantation

Abstract

Abstract Background Transcatheter aortic valve implantation (TAVI) has improved prognosis and quality of life of patients with severe aortic stenosis (AS) who had been considered inoperable or at high risk for surgical aortic valve replacement reflecting their age, frailty, and comorbidities. However, less is known about changes in cardiac geometry after TAVI procedure, and predictors of them. Purpose To clarify changes in cardiac geometry after TAVI, and their predictors. Methods We retrospectively analyzed patients with severe AS who underwent TAVI in our institute between May 2016 and June 2018. Of the 117 consecutive patients enrolled to this study, 12 patients died before six-month follow up, and finally 88 patients received follow up exams including echocardiography at six months after TAVI procedure. Results The analysis of echocardiographic data at the baseline and the six-month follow up of the 88 patients (age 86.2±4.0 years, male 19.3%, STS-PROM 6.76±3.28%, peak aortic jet velocity 4.67±0.75m/s) revealed that left ventricular end-diastolic volume index (LVEDVi) (from 80.1±20.9ml/m2to 74.2±15.9ml/m2, p=0.011), and left ventricular mass index (LVMi) (from 116.0±32.7g/m2to 93.6±25.6g/m2, p<0.001) had improved in six months after TAVI procedure. The difference of LVEDVi (ΔLVEDVi: six-month LVEDVi–baseline LVEDVi) and the difference of LVMi (ΔLVMi: six-month LVMi – baseline LVMi) were significantly higher in the patients with chronic atrial fibrillation compared to the rest (ΔLVEDVi: +7.7±8.7ml/m2 vs −7.2±18.1ml/m2, p=0.024; ΔLVMi: +7.1±11.5g/m2 vs −25.3±33.5g/m2, p=0.008). In echocardiographic data, ΔLVEDVi and ΔLVMi both had positive correlation between baseline E/e' ratio (ΔLVEDVi: r=0.224, p=0.048; ΔLVMi: r=0.240, p=0.034), and negative correlation between baseline LVEDVi (ΔLVEDVi: r=−0.674, p<0.001; ΔLVMi: r=−0.312, p=0.003), LVMi (ΔLVEDVi: r=−0.422, p<0.001; ΔLVMi: r=−0.699, p<0.001), peak aortic jet velocity (ΔLVEDVi: r=−0.257, p=0.016; ΔLVMi: r=−0.376, p<0.001), and mean transaortic pressure gradient (ΔLVEDVi: r=−0.269, p=0.011; ΔLVMi: r=−0.403, p<0.001). Conclusion TAVI resulted in reverse remodeling and regression of hypertrophy in left ventricle. And these improvement were grater in patients with more advanced left ventricular remodeling and hypertrophy, and higher severity of AS at the baseline, however, less in patients with chronic atrial fibrillation and worse diastolic dysfunction.