Abstract 280 Echocardiographic left-ventricular reverse remodeling after transcatheter aortic valve implantation in patients with low-flow low-gradient aortic stenosis

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02087-y
Echocardiographic left-ventricular reverse remodeling after transcatheter aortic valve implantation in patients with low-flow low-gradient aortic stenosis
N. Wilde¹, V. Mauri², K. Piayda³, B. Al-Kassou⁴, J. Shamekhi⁴, O. Maier³, V. Tiyerili⁵, A. Sugiura⁴, M. Weber⁴, S. Zimmer⁴, T. Zeus³, M. Kelm³, M. Adam², S. Baldus⁶, G. Nickenig⁴, V. Veulemans³, A. Sedaghat⁴
¹Medizinische 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; ⁴Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn; ⁵Klinik für Innere Medizin I, Kath. St. Paulus Gesellschaft, Dortmund; ⁶Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Köln;
Background: Left-ventricular reverse remodeling (LVRR) is associated with improved outcome in patients with heart failure. In patients with reduced left-ventricular ejection fraction (LVEF) undergoing transcatheter aortic valve implantation (TAVI), data on factors associated with LVRR and its impact are not well studied. Objectives: Outcome and predictive factors for positive remodeling in patients showing LVRR after TAVI with low-flow low-gradient (LFLG) aortic stenosis (AS) were assessed. Methods: Pre- and post-procedural left-ventricular (LV) function and volume were investigated in 219 LFLG patients. LVRR was defined as increase in LVEF of ≥ 10% and reduction in LV end-systolic volume of ≥ 15%. The primary endpoint was set as the combination of all-cause mortality and rehospitalization for heart failure. Results: Mean LVEF was 35.0 ± 10.0% with a stroke volume index (SVI) of 25.9 ± 6.0ml/m² and a LV end-systolic volume (LVESV) of 94.04 ± 46.0ml. At a median of 5.2 months (IQR 2.7 – 8.1months), 77.2 % (n=169) of the patients showed echocardiographic evidence of LVRR. A multivariable model revealed three independent factors for LVRR after TAVI: 1) SVI of < 25ml/m² (HR 2.31, 95%CI 0.08 – 3.58; p < 0.01), 2) LVEF < 30% (HR 3.98, 95%CI 0.83 – 2.94; p < 0.01) and 3) valvulo-arterial impedance (Z_va) < 5 mmHg/ml/m² (HR 5.36, 95%CI 1.80 – 15.98; p < 0.01). Patients without evidence of LVRR showed significantly higher incidence of the one-year combined endpoint (64.0% vs. 44.4%; p < 0.01). Conclusions: The majority of patients with LFLG AS show LVRR after TAVI, which is associated with favorable outcome. An SVI of < 25ml/m², LVEF < 30% and Z_va< 5 mmHg/ml/m² represent predictors of LVRR.
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