Affiliation:
1. Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
2. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
Abstract
Background
Reversibility of left ventricular (
LV
) dysfunction in high‐risk aortic stenosis patient and its impact on survival after transcatheter aortic valve replacement (
TAVR
) are unclear. We aimed to evaluate longitudinal changes of
LV
structure and function after
TAVR
and their impact on survival.
Methods and Results
We studied 209 patients with aortic stenosis who underwent
TAVR
from May 2006 to December 2012. Echocardiograms were used to calculate
LV
end‐diastolic volume index (LV
EDV
i),
LV
ejection fraction,
LV
mass index (
LVM
i), and global longitudinal strain before, immediately (<10 days), late (1–3 months), and yearly after
TAVR
. During a median follow‐up of 1345 days, 118 patients died, with 26 dying within 1 year. Global longitudinal strain,
LVEDV
i,
LV
ejection fraction, and
LVM
i improved during follow‐up. In patients who died during the first year, death was preceded by
LVEDV
i and
LVM
i increase. Multivariable longitudinal data analysis showed that aortic regurgitation at baseline, aortic regurgitation at 30 days, and initial
LVEDV
i were independent predictors of subsequent
LVEDV
i. In a joint analysis of longitudinal and survival data, baseline Society of Thoracic Surgeons score was predictive of survival, with no additive effect of longitudinal changes in
LVEDV
i,
LVM
i, global longitudinal strain, or
LV
ejection fraction. Presence of aortic regurgitation at 1 month after
TAVR
was the only predictor of 1‐year survival.
Conclusions
LV
reverse remodeling was observed after
TAVR
, whereas lack of
LVEDV
i and
LVM
i improvement was observed in patients who died during the first year after
TAVR
. Post‐
TAVR
, aortic regurgitation blocks reverse remodeling and is associated with poor 1‐year survival after
TAVR
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
66 articles.
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