Abstract 18371: Regression of LV Mass After Transcatheter or Surgical Aortic Valve Replacement for Aortic Stenosis in the PARTNER I Trial
Background: Regression of left ventricular hypertrophy (LVH) after aortic valve replacement (AVR) for aortic stenosis is a favorable response to ventricular unloading, but has not been compared in transcatheter (TAVR) vs. surgical AVR (SAVR) vs. medical management (MM).
Methods: The PARTNER I trial randomized high risk patients to SAVR vs. TAVR (Cohort A), and inoperable patients to MM vs. TAVR (Cohort B). Patients with echocardiograms at all time points (baseline, 30, 180, and 365 days) after TAVR (A+B; n=197), SAVR (n=96), or MM (n=33) were stratified by gender-specific tertiles of baseline LV mass index (LVMi, g/m2) and change in LVMi over time was evaluated. We used ASE criteria (LVMi ≥122 g/m2 for women, ≥149 g/m2 for men) to define severe LVH.
Results: Compared to baseline, at 1 year LVMi decreased from 151±40 to 130±33 g/m2 in TAVR (p<0.001), 155±48 to 131±39 g/m2 in SAVR (p<0.001), but not in MM (146±40 to 139±33 g/m2, p=ns). After TAVR and SAVR, regression of LVMi was significant in the middle and highest tertiles of LVMi (all p<0.005), with similar regression in TAVR as SAVR , mostly occurring by 180 days (Figure). At baseline, 56% of men and 70% of women in the AVR groups had severe LVH; compared to 33% of men and 39% of women at 1 year. MM patients showed a trend toward regression in the highest tertile (p=0.07), but not in the middle or lowest tertile. In the lowest tertile of LVMi, no change in LVMi occurred in either AVR group. Change in LVMi (baseline to 1 year) correlated to change in transvalvular mean gradient (baseline to 30 days) in TAVR (r=0.18, p=0.01), but not in SAVR or MM; there was no correlation with change in valve area in any group.
Conclusions: LV mass regression was similar after TAVR or SAVR when baseline LVH was more marked (middle and highest tertiles), although one-third had residual severe LVH at 1 year. LV mass regression shows the end-organ correlates of hemodynamic improvement after both TAVR and SAVR, and requires further study.
- © 2013 by American Heart Association, Inc.