Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9
Left ventricular reverse remodeling in classical LF-LG patients after transcatheter aortic valve replacement – insights from the RhineHeart TAVR Registry
N. Wilde1, A. Sugiura1, V. Mauri2, K. Piayda3, B. Al-Kassou1, J. Shamekhi1, O. Maier3, M. Weber1, S. Zimmer1, T. Zeus3, V. Tiyerili4, M. Adam2, V. Veulemans3, M. Kelm3, S. Baldus5, G. Nickenig1, A. Sedaghat1
1Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn; 2Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Köln; 3Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf; 4Klinik für Innere Medizin I, St.-Johannes-Hospital Dortmund, Dortmund; 5Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Köln;

Objectives: This study sought to assess predictive factors for left ventricular reverse remodeling (LVRR) after transcatheter aortic valve replacement (TAVR) in patients with low-flow low-gradient (LF-LG) aortic stenosis (AS) and to compare the outcome between patients with or without LVRR after TAVR in this subgroup.

Background: Reverse remodeling, defined as an increase in ejection fraction (EF) and reduction in left ventricular end-systolic volume (LVESV) is associated with improved outcome in patients with heart failure. In patients with reduced ejection fraction undergoing TAVR, it remains unknown which factors improve left ventricular function and outcome. 

Methods: Pre- and post-procedural left ventricular function and volumes were investigated in 219 patients from the multicentre RhineHeart TAVR Registry. Reverse remodeling was defined as an absolute increase in left ventricular EF of ≥ 10% and an absolute reduction in LVESV of ≥15%. Predictive factors for LVRR after TAVR were defined according to a Cox regression model and outcome was compared between patients with and without reverse remodeling after TAVR. 

Results: At a median of 5.2 months (IQR 2.7 – 8.1months), 77.2 % (n=169) of the patients showed reverse remodeling after TAVR. A multivariable model revealed two independent factors for a positive remodeling after TAVR: a stroke volume index of < 25ml/m2 (HR 0.21, 95%CI 0.08 – 0.58; p < 0.001) and a LV ejection fraction < 30% (HR 0.88, 95%CI 0.83 – 0.94; p < 0.001). Patients with evidence of reverse remodeling showed significant lower one-year rehospitalization rate due to heart failure (22.4% vs. 34.0%; p = 0.02) and cardiac events (43.8% vs. 60%; p < 0.001). The cumulative mortality rate after one year trended to be lower in patients with reverse remodeling after TAVR (24.9% vs. 38.0%; p = 0.08).

 

Conclusions:  A relevant proportion of patients with LFLG AS show reverse remodeling after TAVR. Hereby, a low EF (< 30%) and a stroke volume index of < 25ml/m2 represented independent predictors of positive remodeling. Patients with evidence of reverse remodeling showed lower rates of rehospitalization and cardiac events at one year, while overall mortality was high.
https://dgk.org/kongress_programme/ht2021/P526.htm