Pre-procedural E/e’ Predicts Left Ventricular RemodellLV filling pressure on LV remodeing in Patients Undergoing Transcatheter Aortic Valve Implantation

Abstract

Background: Transcatheter aortic valve implantation (TAVI) is an alternative treatment for severe symptomatic aortic stenosis (AS) in patients at increased surgical risk. AS induces structural alterations to the left ventricle (LV) that lead to elevated filling pressure. We sought to assess the impact of baseline LV filling pressure on LV remodelling following TAVI. Methods: We reviewed patients undergoing TAVI at a single centre between January 2008 and December 2016. Patients were divided into two cohorts based on echocardiographic estimation of baseline LV filling pressure assessed by the mean E/e’ ratio. The primary endpoint was the change in LV diastology from pre-TAVI to 12 months following the procedure. Results: The study includes 98 patients, 81 patients with a mean E/e’ ≥13 and 17 patients with mean E/e’ <13. Mean LV ejection fraction was 63 ± 7%. Mean aortic valve gradient was similar (51 mmHg vs 48 mmHg, p = 0.46). The high mean E/e’ group had significant improvement in LV mass index (LVMI, p = 0.03) with no significant reduction in mean E/e’ ratio (p = 0.09). In contrast, there was a significantly worsening of mean E/e’ ratio (p = 0.004) with no significant change in LVMI (p = 0.13) in the low E/e’ group. There was no significant change in left atrial volume index and right ventricular systolic pressure in either group. Conclusion: A high pre-operative mean E/e’ ratio (>13) predicts favourable remodelling at 12 months in patients with severe symptomatic AS undergoing TAVI.