Author + information
- ARNAV KUMAR1,
- Kimi Sato1,
- Brandon Jones1,
- Stephanie Lynn Mick1,
- Amar Krishnaswamy1,
- Brian Griffin1,
- L. Leonardo Rodriguez1,
- Samir Kapadia1 and
- Zoran Popovic1
Severe left ventricular hypertrophy (LVH) can be related to advanced fibrosis. We hypothesized that patients with severe LVH might not show adequate left ventricular (LV) function recovery after pressure unloading.
Clinical and echocardiographic data from 218 consecutive patients who underwent transcatheter aortic valve replacement (TAVR) with first generation Edwards SAPIEN valve from May 2006 to December 2012 were retrieved. Longitudinal data analysis of echocardiographic parameters was performed using linear mixed effect model and LVH was used as a covariate. The prognostic ability of potential risk factors including known surgical risk scores [society of thoracic surgeons(STS score) and logistic EuroSCORE], and echocardiographic LV structure and function parameters (LV end-diastolic volume, LV end-systolic volume, LV mass index [LVMi], LV ejection fraction, GLS) were assessed.
During a median follow up of 36 months (IQR 15 to 49 months), 113 (52%) patients had died. The mean age of our patients was 80 ±10 years, 59 % males. In mixed effect model, although LVMi regression was observed independent of baseline LVH severity, patients in highest tertile of LVMi (> 125 g/m2) continued to show highest LVMi during follow-up (p=0.004) (Fig A). Similarly, while significant GLS recovery was observed in all groups, patients in highest tertile had significantly depressed GLS (p<0.001) throughout follow up (Figure B). In Multivariate Cox proportional hazard model analysis, higher baseline STS score (p=0.018, HR: 1.05, 95 % CI: 1.01-1.09) and higher LVMi (p=0.007, HR: 1.01, 95% CI 1-1.01) were independent predictors of mortality. Kaplan-Meier curves also showed that patients in the highest LVMi tertile had higher mortality (p=0.043, HR 1.61, 95%CI: 1.01 to 2.57)(Fig C) throughout follow up. Further, LVMi showed incremental prognostic value (p = 0.003) to predict mortality (Fig D).
Patients with severe LVMi did not show adequate regression or strain recovery. Pre-TAVR STS score and LVMi predicted long term mortality among patients undergoing TAVR.
STRUCTURAL: Valvular Disease: Aortic