Regression of Left Ventricular Mass After Transcatheter Aortic Valve Replacement

Chau, Katherine H.; Douglas, Pamela S.; Pîbarot, Philippe; Hahn, Rebecca T.; Khalique, Omar; Jaber, Wael A.; Cremer, Paul; Weissman, Neil J.; Asch, Federico M.; Zhang, Yiran; Gertz, Zachary M.; Elmariah, Sammy; Clavel, Marie‐Annick; Thourani, Vinod H.; Daubert, Melissa A.; Alu, Maria; Leon, Martin B.; Lindman, Brian R.

doi:10.1016/j.jacc.2020.03.042

Cited by 83 publications

(59 citation statements)

References 51 publications

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“…In this context, one can speculate that reduced residual aortic valve area and increased residual transvalvular gradients may be associated with worse remodeling after TAVR. However, neither our study nor the PARTNER sub-analysis [11,12] observed such association. Either the differences in residual gradients are too small to have a meaningful clinical relevance or other factors such as AF or baseline LVMI have a much greater effect on remodeling than these prosthesis parameters.…”

Section: Discussioncontrasting

confidence: 95%

“…Sub-analyses of the Placement of Aortic Transcatheter Valves (PARTNER) trials already showed a strong association of LV mass regression with clinical outcome including mortality and rehospitalization after TAVR [11,12]. However, they did not conduct a possible influence of AF.…”

Section: Discussionmentioning

confidence: 99%

“…There is a growing body of evidence that positive LV remodeling expressed by LV mass regression after TAVR is associated with increased survival [11,12]. However, the association of LV mass alterations following TAVR with AF as another possible factor influencing the outcome after the procedure is unknown.…”

Section: Introductionmentioning

confidence: 99%

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Impact of sinus rhythm versus atrial fibrillation on left ventricular remodeling after transcatheter aortic valve replacement

et al. 2021

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Aims Atrial fibrillation (AF) is associated with increased mortality after transcatheter aortic valve replacement (TAVR). Cerebrovascular complications and bleeding events associated with anticoagulation therapy are discussed to be possible causes for this increased mortality. The present study sought to assess whether AF is associated with impaired left ventricular (LV) reverse remodeling representing another possible mechanism for poor outcome. Methods All patients who underwent TAVR in our institution and had 1-year echocardiography follow-up were included. LV mass index (LVMI) at baseline and follow-up as well as LVMI change at 1 year were assessed with respect to the presence of AF (either at baseline or during hospitalization after TAVR) and sinus rhythm (SR). Results A total of 213 patients (n = 95 in AF; n = 118 in SR) were enrolled in the present study. Patients with AF had higher LVMI at 1 year compared to those with SR (173 ± 61 g/m2 vs. 154 ± 55 g/m2; p = 0.02) and they showed lower relative LVMI change at 1 year (− 2 ± 28% vs. − 9 ± 29%; p = 0.04). In linear regression analysis, AF was independently associated with relative LVMI change (regression coefficient ß 0.076 [95% CI 0.001–0.150]; p = 0.04). With respect to clinical outcome depending on AF and LVMI regression, the Kaplan–Meier estimated event-free of death or cardiac rehospitalization at 3 years was lowest among patients with AF and no LVMI regression. Conclusions The present study identified a significant association of AF with changes in LVMI after TAVR, which was also shown to be associated with clinical outcome.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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Impact of sinus rhythm versus atrial fibrillation on left ventricular remodeling after transcatheter aortic valve replacement

et al. 2021

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“…Furthermore, greater LVMI regression at 1 year was independently associated with lower adjusted risks of clinical events, including all-cause death and rehospitalization between 1 and 5 years, in previous study. 37 In the present study, among patients with LVMI regression at 1 year, women had a survival advantage compared with men, but there was no significant difference in survival between men and women among patients without LVMI regression. Women with LVMI regression had a better prognosis over the long-term follow-up.…”

Section: Sex-related Differences In Outcomes Between Patients With and Without Lvmi Regressioncontrasting

confidence: 50%

Effect of Sex on Mortality and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation

Shishido

Yamanaka

Ochiai

et al. 2021

Circ J

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“…In addition, Chau et al also reported the significant impact of 1-year LVH regression on 5-year outcome from the Partner trial data sub-study that included 1434 AS patients. The quartile with least regression of LV mass index was associated with adjusted HR 1.71 of allcause mortality at 5 years, when compared with the quartile of greatest LV mass regression [31]. The underlying mechanism of residual LVH is complex and often due to events beyond the valve prosthesis hemodynamic performance itself.…”

Section: Effects Of Prosthetic Valve Hemodynamics On the Regression Of Lvhmentioning

confidence: 98%

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement

Jin

Petrou

et al. 2021

Front. Med.

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Over the last half century, surgical aortic valve replacement (SAVR) has evolved to offer a durable and efficient valve haemodynamically, with low procedural complications that allows favourable remodelling of left ventricular (LV) structure and function. The latter has become more challenging among elderly patients, particularly following trans-catheter aortic valve implantation (TAVI). Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss, valvular-vascular impedance to myocardial activation, force-velocity relationship, and myocardial strain. LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour. Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome. Physiological pacing via the His-Purkinje system for conduction abnormalities, further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression, LV coordinate contraction, and global vascular function. TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions. Until comparable long-term durability and the resolution of TAVI related complications become available, SAVR remains the first choice for lower risk younger patients.

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Regression of Left Ventricular Mass After Transcatheter Aortic Valve Replacement

Cited by 83 publications

References 51 publications

Impact of sinus rhythm versus atrial fibrillation on left ventricular remodeling after transcatheter aortic valve replacement

Impact of sinus rhythm versus atrial fibrillation on left ventricular remodeling after transcatheter aortic valve replacement

Effect of Sex on Mortality and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation

Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement

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