The Impact of Severe Ventricular Remodeling on Quality-of-Life Outcomes after Transcatheter Aortic Valve Replacement

Abstract

AbstractBackgroundAmong patients with aortic stenosis, severe ventricular remodeling can limit the augmentation of flow with exertion, even after valve intervention. While long-term mortality risk has been shown be elevated in this patient population, the effect on quality of life (QoL) improvement has not been studied. Our objective was to determine the effect of severe ventricular remodeling on QoL outcomes after transcatheter aortic valve replacement (TAVR).MethodsAll patients undergoing TAVR from 2011-2021 at our institution were included. Groups were divided according to guideline-recommended cutoffs for left ventricular (LV) wall thickness. Normal or mild wall thickness was designated as non-remodeled (NR) and moderate/severe wall thickness defined the remodeled group (REM). The Kansas City Cardiomyopathy Questionnaire (KCCQ) was utilized to assess QoL and the primary outcome was KCCQ change <5 from baseline to 30 days and 1 year.ResultsWe analyzed 679 patients (NR: N=389, REM: N=290). Baseline KCCQ overall score [OS] trended higher in the NR group (60.1 vs. 56.6, p=0.053). Echocardiographic baseline differed between NR and REM by septal thickness (1.12 cm vs. 1.44 cm, p<0.001), posterior wall thickness (1.08 cm vs. 1.33 cm, p<0.001), and LV internal diastolic diameter (4.34 cm vs. 4.19 cm, p=0.006). The primary outcome was similar between NR and REM at 30 days (31.6% vs. 28.6%, p=0.449) and at 1 year (27.7% vs. 21.5%, p=0.217). NR and REM experienced similar proportions of worsening or no change, small, moderate, and large improvements in KCCQ score (<5, 5-10, 10-19, ≥20, respectively). Both groups experienced similar domain score changes and NYHA improvement. At one year, NR demonstrated greater reduction in 5MWT time compared to REM (−1.98 s vs. -0.2 s, p=0.028). A subgroup analysis of REM patients did not reveal interaction with cavity size, stroke volume, mitral regurgitation, E/A ratio, valvulo-arterial impedance, or hyperdynamic ejection fraction.ConclusionsPatients with severe ventricular remodeling and aortic stenosis have similar QoL changes after intervention compared to patients without significant remodeling. Findings from this study support aortic valve intervention irrespective of ventricular remodeling.What is Known; What the Study AddsWhat is Known?Ventricular remodeling occurs due to aortic stenosis, limiting cardiac output even after valve replacement.The effect of ventricular remodeling on quality of life after TAVR is unknown.What the Study AddsQuality of life improvement occurred in the majority of patients undergoing TAVR, with and without severe ventricular remodeling, and to a similar degree regardless of remodeling.From a quality-of-life perspective, TAVR should remain a viable consideration for patients with severe ventricular remodeling