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Impact of transcatheter aortic valve replacement on left ventricular hypertrophy, diastolic dysfunction and quality of life in patients with preserved left ventricular function

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Abstract

Severe aortic stenosis (AS) is associated with left ventricular (LV) hypertrophy and diastolic dysfunction (LVDD). Due to positive impact on transvalvular hemodynamics, transcatheter aortic valve replacement (TAVR) is expected to improve LV remodeling, LVDD and heart failure (HF)-related quality-of-life (QoL). We identified patients with severe AS and LV ejection fraction (LVEF) ≥ 50% who underwent TAVR. We reviewed pre-procedure, 1-month and 1-year post-TAVR transthoracic echocardiograms to assess LV volumetric changes and diastolic function. QoL was assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ). In 171 patients studied, we found significant improvement in LV mass index (LVMI), LV end-systolic diameter and LV end-diastolic diameter from baseline to 1-month to 1-year post-TAVR. Predictors of LVMI regression included greater change from baseline in mean aortic valve (AV) gradient, peak AV velocity, and improvements in septal and lateral e’ velocities and E/e’ post-TAVR. The percentage of patients with ≥ grade 2 LVDD decreased from 65% to 53% at 1-month and 49% at 1-year. A significant improvement in symptomatology, as reported by KCCQ score was also noted. There is conceivable reverse LV remodeling post-TAVR, impacted by improvements in mean AV gradient, peak AV velocity, E/e’, medial and lateral e’ velocities, which occurs immediately post-TAVR and persists up to 1-year post-operatively. This is associated with concomitant improvement in LVDD and HF-related QoL as demonstrated by KCCQ scores.

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Acknowledgements

We would like to acknowledge Dr. Georgios Lygouris, Dr. Orestis Pappas, Dr. Rahul Sinha, and Dr. Manik Veer, Department of Cardiovascular Disease, Allegheny General Hospital for supporting the paper during various stages of investigation and manuscript creation.

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Authors and Affiliations

  1. Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA

    Garima Dahiya & Aditya A. Joshi

  2. Department of Cardiovascular Disease, Allegheny General Hospital, Pittsburgh, PA, USA

    Andreas Kyvernitakis, David M. Lasorda, Amresh Raina, Robert W. W. Biederman & Manreet K. Kanwar

  3. Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA

    Stephen H. Bailey

  4. Advanced Heart Failure, Pulmonary Hypertension and Transplant Cardiology, Allegheny General Hospital, Pittsburgh, PA, 15212, USA

    Manreet K. Kanwar

Authors
  1. Garima Dahiya
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  2. Andreas Kyvernitakis
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  4. David M. Lasorda
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Correspondence to Manreet K. Kanwar.

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Dahiya, G., Kyvernitakis, A., Joshi, A.A. et al. Impact of transcatheter aortic valve replacement on left ventricular hypertrophy, diastolic dysfunction and quality of life in patients with preserved left ventricular function. Int J Cardiovasc Imaging 37, 485–492 (2021). https://doi.org/10.1007/s10554-020-02015-z

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