Abstract 4369: Early Left Ventricular Reverse Remodelling and Hypertrophy Regression Following Percutaneous Aortic Valve Replacement With the Corevalve Bioprosthesis in Patients With Severe Aortic Valve Stenosis
BACKGROUND/AIMS: Severe aortic stenosis (AS) is associated with hypertrophy of the left ventricle (LVH), which is linked to adverse clinical outcomes. To date, the effects of the novel technology of percutaneous aortic valve replacement (PAVR) on LVH in severe AS have not yet been well described. We sought to test the hypothesis that PAVR would result in a rapid regression of LVH and LV mass associated with severe AS.
METHODS: High risk patients affected by severe (AS) were recruited as part of a single-arm, prospective, and clinical outcome study of the third-generation CoreValve percutaneous aortic bioprosthesis. To assess LVH and LV mass at baseline and at 6 month, the parasternal long-axis echocardiographic transthoracic view in end-diastole and end-systole was used.
RESULTS: 27 patients were studied. 11 men and 16women, mean age 83±7yrs, NYHA class improved from 2.6±0.5 to 1.7±0.6 (p=0.001). There were significant periprocedural reductions in peak (85±22mmHg to 17±8 mmHg; p<0.001) and mean (50±14mmHg to 10±5 mmHg; p<0.001) transvalvular gradients. Left ventricular ejection fraction improved from 48±4% to 57±11% (p=0.01). End-diastolic volume remained unchanged (127±63 ml to 125±23, p=n.s.) while end-systolic volumes decreased significantly from 68±42ml to 38+/−33ml (p=0.05). Septal wall thickness regressed by 14% from 14±1.7 cm at baseline, to 12±1.8 mm (p=0.01), and posterior wall thickness regressed by 21% from 14±2 mm to 11±2.5mm (p=0.001). LV mass and LV mass index respectively decrease from 333±85 gr to 267±5 gr and from 188±44 gr/m2 to 150±37 gr/m2(p=0.005, p=0.001).
CONCLUSION: We demonstrate an early regression of both septal and posterior hypertrophy with a reverse remodelling of left ventricular mass in a short period after PAVR for severe AS. These changes may be considered comparable to those seen at 1 year after conventional surgical aortic valve replacement and have in the future an important clinical prognostic value.