Author + information
- Melissa A. Daubert,
- Philippe Pibarot,
- Rebecca Hahn,
- Neil Weissman,
- William Stewart,
- Justina Wu,
- Sammy Elmariah,
- Brian Lindman,
- E. Murat Tuzcu,
- Rakesh Suri,
- Ke Xu,
- Martin Leon and
- Pamela Douglas
Left ventricular (LV) reverse remodeling (RR) is often associated with reduced adverse events. This study evaluated the extent and impact of RR after transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS).
We analyzed patients with at least moderate LV dilation (end-diastolic volume index, EDVi ≥ 87 ml/m2) for RR (EDVi decrease ≥ 5ml/m2) between baseline and 30 days after TAVR. Event rates at 1 year were compared in RR and no RR patients.
Of the 2358 patients, 301 (12.8%) had at least moderate LV dilation and paired baseline and 30-day LV volumes. RR occurred in 209 patients (69.4%). At baseline, those with RR had larger EDVi (p=0.02) and higher peak and mean AS gradients (p=0.007; 0.004), but similar end-systolic volume index (ESVi, p=0.33) and ejection fraction (EF, p=0.09). EDVi and ESVi significantly decreased in patients with RR (both p<0.0001), but increased in those without RR (Table). A significantly greater increase in EF occurred with RR: +3.94 vs +1.41%, p=0.009. Moderate-severe paravalvular aortic regurgitation and mitral regurgitation were more likely at 1 year in patients with no RR (both p=0.02), but rates of all-cause death (p=0.56), cardiac death (p=0.72), and repeat hospitalization (p=0.38) were similar.
Although LV dilation is uncommon in severe AS, such patients demonstrate significant RR after TAVR. However, this did not correlate with reduced events at 1 year suggesting that RR may not be prognostic in this population.
||[Δ No RR] - [Δ RR]|
|BASELINE||30 DAYS||Δ||p-value||BASELINE||30 DAYS||Δ||p-value||
|End-Diastolic Volume Index (ml/m2)||102.70 ± 14.91||112.69 ± 18.80||
||<0.0001||107.54 ± 18.48||74.85 ± 21.56||-32.69 ± 20.06||<0.0001||
|End-Systolic Volume Index (ml/m2)||65.98 ± 19.31||69.00 ± 21.81||
||0.0121||64.03 ± 21.55||42.97 ± 18.23||
|Ejection Fraction (%)||38.53 ± 12.60||39.94 ± 11.64||
||0.0329||41.26 ± 13.21||45.20 ± 11.98||
Poster Hall B1
Saturday, March 14, 2015, 10:00 a.m.-10:45 a.m.
Session Title: Coronary I
Abstract Category: 30. TCT@ACC-i2: Aortic Valve Disease
Presentation Number: 2100-271
- 2015 American College of Cardiology Foundation