Abstract 15554: Continuous Improvement in Cardiac Function After Transcatheter Aortic Valve Replacement Points to Preserved Cardiac Plasticity in Elderly Patients With Severe Aortic Stenosis
Background: While left ventricular (LV) unloading by transcatheter aortic valve replacement (TAVR) in elderly patients with severe aortic stenosis (AS) immediately improves LV hemodynamics, residual abnormalities in LV function often remain. Whether elderly patients demonstrate preserved cardiac plasticity, i.e. ability to additionally improve LV function in following months after TAVR is unclear.
Methods: We retrospectively studied 218 consecutive patients (median age 82 years; Male 59%) who underwent TAVR with the first-generation Edwards SAPIEN valve from 2006 to 2012. Baseline and follow-up echocardiographic studies were assessed to calculate LV mass index (LVMi) and global longitudinal strain (GLS). To assess recovery of LV function that occurs in addition to immediate improvement after TAVR, data obtained ≥3 days after TAVR were analyzed.
Results: After TAVR, there was immediate improvement in GLS within first 3 days (p=0.002), followed by additional improvement over a median of 2 years (-1.0% per year, p=0.009). There was a parallel decrease of LVMi during follow-up (-15g/m2 per year, p<0.001). While baseline GLS was more impaired in younger patients (≤82 years) (p<0.01), males (p<0.001), and those with LV hypertrophy (LVH) (p<0.001), the improvement in GLS was independent of age, gender or LVMi (Figure A). The improvement in LVMi after TAVR was also independent of age, gender and baseline LVH (Figure B). By multivariable linear regression, only higher baseline LVMi (p<0.001,β0.47) predicted LVMi decrease, while lower baseline LV ejection fraction (EF) (p=0.02, β-0.27) and worse baseline GLS (p< 0.001, β-0.69) were associated with better GLS recovery.
Conclusion: Pressure unloading induced by TAVR unmasks the presence of cardiac plasticity in severe AS patients regardless of age, gender, or severity of LVH. Higher baseline LV mass was associated larger LV mass reduction whereas worse baseline LVEF and GLS were associated with better GLS recovery.
Author Disclosures: K. Sato: None. A. Kumar: None. B.M. Jones: None. S.R. Kapadia: None. B.P. Griffin: None. L. Rodriguez: None. Z.P. Popovic: None.
- © 2016 by American Heart Association, Inc.