Abstract 15944: The Natural History and Outcome of Left Heart Remodeling in Patients Undergoing Transcatheter Aortic Valve Replacement
Background: Left heart remodeling after transcatheter aortic valve replacement (TAVR) is poorly characterized.
Methods: Echocardiographic data were systematically collected from a prospective cohort of 311 individuals who underwent TAVR. We calculated left ventricular mass index (LVMi), left atrium diameter index (LADi), and relative wall thickness (RWT) at selected time points. Left ventricular hypertrophy (LVH) was defined and further patients were assigned one of the following geometries: 1) Normal; 2) Concentric remodeling; 3) Concentric hypertrophy; and 4) Eccentric hypertrophy. Reverse remodeling (partial or complete) was defined as normalization of LVMi and/or RWT, and adverse remodeling as an increase in LVMi and/or RWT. The primary end-point was the LVMi and LADi longitudinal change assessed using mixed models. Secondary end-points included reverse or adverse remodeling incidence after TAVR, and VARC outcomes.
Results: Among LVH patients, there was a significant decrease in LVMi (P<0.0001) that was not accompanied by LADi change resulting in a higher LADi at all time points(P=0.006). Reverse and adverse remodeling were observed in 25% and 16% one year after TAVR, respectively (P<0.0001). Normal geometry group had higher rates of aortic regurgitation (P=0.04) accompanied by adverse remodeling and higher rates of atrial fibrillation (P=0.019). Cardiac death and major stroke occurred uniquely among baseline concentric geometries.
Conclusions: Although TAVR reverses ventricular remodeling and hypertrophy induced by aortic stenosis, this remodeling is incomplete in most patients. Moreover, adverse remodeling after TAVR represents a possible causal link between aortic regurgitation and outcome. Our study indicates that the left heart remodeling is a potential target to improve outcomes.
Author Disclosures: M.A. Magalhaes: None. S. Minha: None. F. Chen: None. R.O. Escarcega: None. I.M. Barbash: None. N.C. Baker: None. Z. Wang: None. S. Goldstein: None. F.M. Asch: None. P. Okubagzi: None. R. Torguson: None. I. Ben-Dor: None. L.F. Satler: None. A.D. Pichard: None. R. Waksman: None.
- © 2014 by American Heart Association, Inc.