Abstract 14939: Reverse Left Ventricular remodelling 6 months post-Transcatheter Aortic Valve Implantation compared to Surgical Aortic Valve Replacement. A Cardiovascular Magnetic Resonance Study.
Introduction Transcatheter Aortic Valve Implantation (TAVI) for patients with severe aortic stenosis at unacceptably high surgical risk has been shown to improve survival compared to medical therapy. Our aim was for the first time to use the ‘reference standard’ technique, Cardiovascular Magnetic Resonance (CMR) to accurately demonstrate serial changes in left ventricular (LV) function and mass post TAVI compared to surgical aortic valve replacement (SAVR).
Methods Forty patients (20 TAVI, 20 SAVR) completed baseline and 6 month follow-up 1.5T CMR scans. Patient characteristics were matched for gender (male 10 vs 15, p=0.1) and BMI (27 ±3 vs 27 ±4, p=0.88) but due to TAVI selection criteria not for age (80 ±7 vs 75 ±7, p=0.01) or EuroSCORE (20 ±11 vs 6.7 ±3, p<0.001). CMR analysis was performed by 2 experienced observers blinded to the clinical details. Relevant values were indexed to body surface area (BSA).
Results TAVI resulted in a significant reduction in LV end-systolic volume (ESV) and mass and an increase in ejection fraction (EF). Post SAVR LV end-diastolic volume (EDV), ESV and mass significantly reduced with no significant change in EF (Table 1). EDV was significantly lower (p=0.03) in the SAVR group at 6 months when compared to TAVI. Multivariate analysis identified diabetes as an independent predictor of poor LV mass regression (B 7.6, p=0.02). Gender, CAD, Renal failure and AF had no association to remodelling when controlled for baseline parameters. In SAVR, CABG was associated with higher EDV and stroke volume at 6 months (B 11.7, p=<0.001 and B 5.7, P=0.04).
Conclusion In high risk patients, TAVI resulted in comparable levels of LV reverse remodelling to lower risk SAVR patients. TAVI significantly improved LV ESV, mass and EF at 6 months. No specific variable predicted reverse remodelling although LV mass reduction was less pronounced in diabetic patients. These changes in ventricular remodelling may be responsible for the reported improved prognosis post TAVI.
- © 2011 by American Heart Association, Inc.