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Prognostic implications of residual left ventricular hypertrophy and systolic dysfunction in aortic stenosis following transcatheter aortic valve replacement

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Abstract

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.

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Abbreviations

AS:

Aortic stenosis

AVR:

Aortic valve replacement

GLS:

Global longitudinal strain

LV:

Left ventricle

LVEF:

Left ventricle ejection fraction

LVH:

Left ventricle hypertrophy

LVM:

Left ventricle mass

LVMi:

Left ventricle mass indexed

mFS:

Midwall fractional shortening

TAVR:

Transcatheter aortic valve replacement

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Funding

This study was supported by a grant from The Independent Research Fund Denmark (Grant No. 9058-0000448B).

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Authors and Affiliations

  1. Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Anders Lehmann Dahl Pedersen, Jonas Agerlund Povlsen, Vibeke Guldbrand Rasmussen, Christian Alcaraz Frederiksen, Evald Høj Christiansen, Christian Juhl Terkelsen, Henrik Vase & Steen Hvitfeldt Poulsen

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  1. Anders Lehmann Dahl Pedersen
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  2. Jonas Agerlund Povlsen
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  3. Vibeke Guldbrand Rasmussen
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  4. Christian Alcaraz Frederiksen
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  5. Evald Høj Christiansen
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  6. Christian Juhl Terkelsen
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  7. Henrik Vase
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  8. Steen Hvitfeldt Poulsen
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Authors ALDP and SHP wrote the manuscript draft. All authors reviewed the manuscript.

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Correspondence to Anders Lehmann Dahl Pedersen.

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Pedersen, A.L.D., Povlsen, J.A., Rasmussen, V.G. et al. Prognostic implications of residual left ventricular hypertrophy and systolic dysfunction in aortic stenosis following transcatheter aortic valve replacement. Int J Cardiovasc Imaging 39, 13–22 (2023). https://doi.org/10.1007/s10554-022-02688-8

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  • DOI: https://doi.org/10.1007/s10554-022-02688-8

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