Impact of Left Ventricular Inflow-Outflow Angle on Heart Failure Readmission Post- Transcatheter Aortic Valve Implantation

Abstract

Abstract Purpose Heart failure (HF) readmission post-transcatheter aortic valve implantation (TAVI) is common; however, its anatomical predictors remain unclear. This study aimed to assess the impact of the left ventricular inflow-outflow (LVIO) angle, evaluated using computed tomography, on HF readmission post-TAVI. Methods Consecutive patients who underwent transfemoral TAVI for native tricuspid aortic stenosis without histories of valve surgery or bicuspid aortic valve were assessed. The included patients were dichotomized into the small and large LVIO groups based on a mean systolic LVIO angle. The incidence of HF readmission within 1 year post-TAVI was compared between the two groups, in addition to patients’ and procedural characteristics and performance of transcatheter heart valves. Cox regressions were performed to identify predictors of HF readmission. Results Of 163 patients, 70 (43%) patients were classified as the small LVIO group. Additionally, 9 (5.5%) were readmitted for HF, and 7 (4.3%) died within 1 year post-TAVI. The small LVIO group had a significantly higher rate of HF readmission within 1 year post-TAVI than the large LVIO group (8 [11.4%] vs. 1 [1.1%], p < 0.01). However, the transvalvular mean gradient and residual aortic regurgitation post-TAVI did not differ between the two groups. Cox proportional hazard regression demonstrated that a small systolic LVIO angle was an independent predictor of HF readmission within 1 year post-TAVI (hazard ratio, 10.70; 95% confidence interval, 1.32–86.87; p = 0.03). Conclusion A small systolic LVIO angle was associated with HF readmission within 1 year post-TAVI. Patients with a small systolic LVIO angle may require close follow-up post-TAVI.