P6485Incremental prognostic value of electrocardiographic strain after transcatheter aortic valve replacement for aortic stenosis

Abstract Background Electrocardiographic (ECG) strain pattern has recently been associated with increased adverse outcome in aortic stenosis (AS) and after surgical aortic valve replacement (AVR). However, the relation linking ECG strain and cardiovascular MACE in patients with transcatheter aortic valve replacement (TAVR) has not been yet described. Objectives The aim of our study was to determine the impact and incremental value of ECG Strain pattern in predicting adverse outcome after TAVR. Methods 585 patients with severe AS (mean age: 83±7 male 39.8%) were enrolled from November 2012 to May 2018. ECG strain pattern was defined as ≥1 mm concave down-sloping ST-segment depression and asymmetrical T-wave inversion in the lateral leads. Patients with baseline left bundle branch block (LBBB), right bundle branch block (RBBB) or ventricular paced rhythm were excluded. All patients underwent transthoracic echocardiography (TTE) before TAVR and at 30 days follow up. The primary endpoints of the study were the overall all-cause mortality after TAVR, rehospitalization for Hearth failure (HF), myocardial infarction and stroke. Results 178 (30.4%) patients were excluded from analyses owing to the presence of either LBBB (n=103) or RBBB (n=75). Among the 407 remaining patients, 106 had ECG strain pattern (26.04%). Patients with ECG strain were significantly younger (81.6±8 years vs 83.5±6.8 years; p=0.022), had lower BMI (23±4.5 kg.m2 vs 27.9±6.8 kg.m2; p=0.02) more severe AS (mean gradient 52.3±15.2 mmHg vs 47.9±11.8 mmHg; p=0.003), significant lower LVEF (51.8±15% vs 58.4±10.7%; p<0.001). Left ventricular hypertrophy (LVH) was more frequent in patients with ECG Strain (indexed left ventricular mass (135.9±33.4 g.m2 vs 123.6±31.9 g.m2; p=0.002)). Death from any cause (22 (20.8%) vs 61 (20.3%); p=0.508) did not differ significantly between groups. Major adverse cardiovascular events (MACE) including death, stroke and heart failure at 1 month showed similar incidence (7 (6.6%) vs 17 (5.6%), p=0.439). Rehospitalization for hearth failure (HF) was significantly higher (33 (31.1%) vs 33 (11%); p<0.001) in patients with ECG strain pattern. In univariate model, ECG Strain was a strong predictor of rehospitalization for HF (HR 2.621 95% CI (1.607–4.277), p=0.001), independently of LVH assessed either by ECG criteria (HR 1.181 95% CI (0.698–1.997; p=0.536) or TTE (HR 1.557 95% (CI 0.701–3.458; p=0.277). ECG Strain remained associated with a higher risk of rehospitalization for hearth failure in multivariate analyses (HR 2.747 95% (CI 1.614- 4.674); p<0.001) Conclusion In patients with AS eligible for TAVR, ECG Strain Pattern is frequent and associated with an increased risk of post interventional heart failure regardless of preoperative LVH. ECG Strain pattern represents an easy, objective, reliable and low-cost tool to identify patients who may benefit from an extend and intensified post-interventional follow-up.

Download Full-text

Electrocardiographic Strain Pattern Is a Major Determinant of Rehospitalization for Heart Failure After Transcatheter Aortic Valve Replacement

Journal of the American Heart Association ◽

10.1161/jaha.119.014481 ◽

2021 ◽

Vol 10 (3) ◽

Author(s):

Joé Heger ◽

Antonin Trimaille ◽

Marion Kibler ◽

Benjamin Marchandot ◽

Marilou Peillex ◽

...

Keyword(s):

Heart Failure ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Bundle Branch Block ◽

Strain Pattern ◽

Transcatheter Aortic Valve

Background Electrocardiographic strain pattern (ESP) has recently been associated with increased adverse outcome in aortic stenosis and after surgical aortic valve replacement. Our study sought to determine the impact and incremental value of ESP pattern in predicting adverse outcome after transcatheter aortic valve replacement. Methods and Results A total of 585 patients with severe aortic stenosis (mean age, 83±7 years; men, 39.8%) were enrolled for transcatheter aortic valve replacement from November 2012 to May 2018. ESP was defined as ≥1‐mm concave down‐sloping ST‐segment depression and asymmetrical T‐wave inversion in the lateral leads. The primary end points of the study were all‐cause mortality, rehospitalization for heart failure, myocardial infarction, and stroke. A total of 178 (30.4%) patients were excluded because of left bundle‐branch block (n=103) or right bundle‐branch block (n=75). Among the 407 remaining patients, 106 had ESP (26.04%). At a median follow‐up of 20.00 months (11.70–29.42 months), no impact of electric strain on overall and cardiac death could be established. By contrast, incidence of rehospitalization for heart failure was significantly higher (33/106 [31.1%] versus 33/301 [11%]; P <0.001) in patients with ESP. By multivariate analyses, ESP remained a strong predictor of rehospitalization for heart failure (hazard ratio, 2.75 [95% CI, 1.61–4.67]; P <0.001). Conclusions In patients with aortic stenosis who were eligible for transcatheter aortic valve replacement, ESP is frequent and associated with an increased risk of postinterventional heart failure regardless of preoperative left ventricular hypertrophy. ESP represents an easy, objective, reliable, and low‐cost tool to identify patients who may benefit from intensified postinterventional follow‐up.

Download Full-text

The discongruence index, a simple predictor of cardiac remodeling after transcatheter aortic valve replacement

European Heart Journal ◽

10.1093/eurheartj/ehab724.086 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

F Islas ◽

A De Agustin ◽

P Jimenez ◽

L Nombela ◽

P Marcos Alberca ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Cardiac Remodeling ◽

Transcatheter Aortic Valve Replacement ◽

Left Ventricular ◽

Volume Index ◽

Left Ventricular Ejection ◽

Transcatheter Aortic Valve

Abstract Background Aortic stenosis causes several changes in left ventricular (LV) geometry and function; cardiac remodeling after transcatheter aortic valve replacement (TAVR) is variable among patients and it is not clearly defined. The aim of this study is to identify factors associated with LV functional and structural recovery. Methods 428 patients were retrospectively studied; all patients underwent transthoracic echocardiography prior to TAVR; specific measurements such as maximum internal diameter of the prosthetic valve, nominal loss and percentage of nominal loss regarding to valve size, as well as the discongruence index (Prosthesis size/BSA) were evaluated at discharge and 1-year follow up. Positive cardiac remodeling (PCR) was considered if patients had a reduction of ≥20% of left ventricle mass index (LVMi) and ≥10% of end-diastolic volume index (LVEDVi). Results Mean age of the cohort was 83±5.6 years, 55% were female (n=236), mean aortic valve area was 0.7±0.2cm2; mean LVMi and LVEDVi were 129.4±35.4gr/m2 and 54.5±22ml/m2 respectively. LVMi reduction ≥20% was observed in 30% (n=128) of patients; LVEDVi reduction ≥10% was observed in 44% (n=188) of patients. A total of 107 patients (25%) showed PCR. Female patients showed more PCR (p=0.04). Discongruence index was significantly higher in patients with PCR (15.5±1.9 vs 14.5±1.8, p=0.01) and was significantly associated to LVMi (121.5±28.9 vs 150.8±41.1g/m2) and LVEDVi individually (55.1±17.2 vs 42.7±16.7ml/m2; p<0.01). Left ventricular ejection fraction (LVEF) had a statistically significant increase among patients with PCR (53.2±14.9 vs 56.7±11.5, p=0.04) global longitudinal strain showed improvement at 1-year follow-up as well, although not statistically significant (−17.3±3.7 vs −18.3±3.4 p=0.53). Conclusions The discongruence index is a simple and feasible parameter that can predict positive cardiac remodeling after TAVR which can have a significant impact in clinical outcome of patients. FUNDunding Acknowledgement Type of funding sources: None.

Download Full-text

Anatomical Predictors of Pacemaker Dependency after Transcatheter Aortic Valve Replacement

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.120.009028 ◽

2020 ◽

Author(s):

Luca Nai Fovino ◽

Alberto Cipriani ◽

Tommaso Fabris ◽

Mauro Massussi ◽

Andrea Scotti ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Conduction Disturbances ◽

Transcatheter Aortic Valve ◽

Left Ventricular Outflow

Background - Conduction disturbances after transcatheter aortic valve replacement (TAVR) are often transient. Limited data exist on anatomic factors predisposing to PM dependency after TAVR. We sought to assess the rate and the possible predictors of pacemaker (PM) dependency after transcatheter aortic valve replacement (TAVR). Methods - Consecutive patients undergoing PM implantation up to 30-day after TAVR between May 2014 and September 2019 were included. Baseline electrocardiographic, computed tomography and procedural characteristics were collected, including valve implantation depth (ID) and membranous septum (MS) length, an anatomic surrogate of the distance between the aortic annulus and the His bundle. PM dependency at 30-day and 1-year and all-cause mortality during follow up were evaluated. Results - Of 728 TAVR patients, 112 (53.5% males, median age 81) underwent PM implantation after TAVR. Of these, 44.6% (50/112) were PM-dependent at 30-day, 46.7% (36/77) at 1-year. By multivariate analysis, independent predictors of 30-day PM dependency included left ventricular outflow tract (LVOT) calcifications under the left coronary cusp (LCC) (OR: 5.69, 95%CI: 1.45-22.31, p=0.013) and a difference between MS length and ID (ΔMSID) ≥3 mm (OR: 7.58, 95%CI: 2.07-27.78, p=0.002). Conversely, MS length and ID alone were not associated with PM dependency (OR: 0.79, 95%CI: 0.60-1.05, p=0.11 and OR: 1.11, 95%CI: 0.99-1.24, p=0.08). At a median follow-up of 28.1 [11.7-48.6] months, PM-dependent patients did not show a worse survival (p=0.26). Conclusions - Less than half of the patients undergoing PM implantation after TAVR are PM-dependent at mid-term follow-up. ΔMSID ≥3mm and presence of LVOT calcifications under the LCC, but not MS length nor ID alone, are predictive of long-term PM dependency after TAVR, thus influencing device selection and programming.

Download Full-text

Impact of conduction disturbances on left ventricular mass regression and geometry change following transcatheter aortic valve replacement

Scientific Reports ◽

10.1038/s41598-021-96297-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tsung-Yu Ko ◽

Hsien-Li Kao ◽

Ying-Ju Liu ◽

Chih-Fan Yeh ◽

Ching-Chang Huang ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Pacemaker Implantation ◽

Left Ventricular ◽

Conduction Disturbances ◽

Transcatheter Aortic Valve ◽

Lv Mass

AbstractOur study aimed to compare the difference of LV mass regression and remodeling in regard of conduction disturbances (CD) following transcatheter aortic valve replacement (TAVR). A prospective analysis of 152 consecutive TAVR patients was performed. 53 patients (34.9%) had CD following TAVR, including 30 (19.7%) permanent pacemaker implantation and 23 (15.2%) new left bundle branch block. In 123 patients with 1-year follow-up, significant improvement of LV ejection fraction (LVEF) (baseline vs 12-month: 65.1 ± 13.2 vs 68.7 ± 9.1, P = 0.017) and reduced LV end-systolic volume (LVESV) (39.8 ± 25.8 vs 34.3 ± 17.1, P = 0.011) was found in non-CD group (N = 85), but not in CD group (N = 38). Both groups had significant decrease in LV mass index (baseline vs 12-month: 148.6 ± 36.9 vs. 136.4 ± 34.7 in CD group, p = 0.023; 153.0 ± 50.5 vs. 125.6 ± 35.1 in non-CD group, p < 0.0001). In 46 patients with 3-year follow-up, only non-CD patients (N = 28) had statistically significant decrease in LV mass index (Baseline vs 36-month: 180.8 ± 58.8 vs 129.8 ± 39.1, p = 0.0001). Our study showed the improvement of LV systolic function, reduced LVESV and LV mass regression at 1 year could be observed in patients without CD after TAVR. Sustained LV mass regression within 3-year was found only in patients without CD.

Download Full-text

Early haemodynamic and structural impact of transcatheter aortic valve replacement in pure aortic regurgitation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1919 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Graziani ◽

E Mencarelli ◽

F Burzotta ◽

L Paraggio ◽

C Aurigemma ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Aortic Regurgitation ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Ventricular ◽

Transcatheter Aortic Valve ◽

Structural Impact ◽

Before And After

Abstract Background Patients with severe aortic regurgitation (AR) are treated by surgery and have variable left-ventricular (LV) “reverse remodelling” after intervention. Transcatheter-aortic-valve replacement (TAVR) might be considered in selected AR patients. Purpose To evaluate the hemodynamic and structural impact of TAVR in patients with pure AR. Methods Consecutive AR patients underwent TAVR in our Institution were identified. Left heart catheterization before and after TAVR and complete echocardiographic assessment before TAVR, after (24–72 hours) TAVR and at follow-up (3–12 months) were systematically performed. Hemodynamic and echocardiographic parameters were compared before and after TAVR. Results Twenty-two patients with severe AR, high surgical risk and advanced heart damage were treated by TAVR using mainly self-expandable prostheses. The procedure was successful in 21 patients (95.5%). An immediate hemodynamic impact of the TAVR procedure was documented by different parameters and included significant decrease in LV end-diastolic pressure (from 26.2 to 20.1 mmHg, P=0.012). Significant reduction in LV size (left ventricular end diastolic diameter (LVEDD): 60.0±8.0 mm vs 54.6±8.1 mm, p=0.002) and mass (left ventricular mass indexed (LVMi): 163.2±58.8 g/m2 vs 140.2±45.6 g/m2, p 0.004) as well as a sharp reduction in systolic-pulmonary-arterial-pressure (48.3±17.6 vs 32.9±7.8 mmHg, p<0.0001) was documented at 24–72 hours. Furthermore, patients with baseline moderate-to-severe mitral and tricuspid regurgitation showed a significant, early, valvular regurgitation reduction. All favourable changes persisted at follow-up. More pronounced LVEDD reduction was predicted by baseline LVEDD (p=0.019). Conclusions In patients with severe AR, TAVR determines a profound impact on heart remodelling, which is early detectable and durable. Impact of TAVR in pure AR Funding Acknowledgement Type of funding source: None

Download Full-text

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

Clinical Research in Cardiology ◽

10.1007/s00392-021-01810-5 ◽

2021 ◽

Author(s):

Jakob Ledwoch ◽

Carolin Fröhlich ◽

Ida Olbrich ◽

Felix Poch ◽

Ruth Thalmann ◽

...

Keyword(s):

Atrial Fibrillation ◽

Aortic Valve ◽

Clinical Outcome ◽

Aortic Valve Replacement ◽

Sinus Rhythm ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Ventricular ◽

Transcatheter Aortic Valve

Abstract 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.

Download Full-text

Timing and evolution of advanced conduction disturbances in patients with right bundle branch block undergoing transcatheter aortic valve replacement

EP Europace ◽

10.1093/europace/euaa149 ◽

2020 ◽

Vol 22 (10) ◽

pp. 1537-1546

Author(s):

Guillem Muntané-Carol ◽

David del Val ◽

Lucía Junquera ◽

Laurent Faroux ◽

Robert Delarochellière ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Right Bundle Branch Block ◽

Transcatheter Aortic Valve Replacement ◽

Ventricular Pacing ◽

Bundle Branch Block ◽

Conduction Disturbances ◽

Transcatheter Aortic Valve

Abstract Aims This study sought to determine the timing and evolution over time of advanced conduction disturbances (CDs) in patients with baseline right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR). Methods and results One hundred and ten consecutive patients with pre-existing RBBB were included (out of 1341, 8.2%). All arrhythmias during the hospitalization period were recorded. Follow-up was performed at 30 days, 1 year, and yearly thereafter. Conduction recovery and ventricular pacing percentage (VPP) was evaluated at 30 days in those patients with permanent pacemaker implantation (PPMI). Sixty-one (55.5%) patients suffered advanced CDs [97% complete or high-degree atrioventricular block (CHB/HAVB)], and the vast majority (98%) occurred within the first 3 days post-procedure (intraprocedural: 85%). Fifty-two (47.3%) patients had PPMI (vs. 11.0% in non-RBBB patients, P < 0.001). Ventricular pacing percentage at 1 month was higher in patients with persistent-intraprocedural CHB/HAVB compared to those with transient-intraprocedural or post-procedural CHB/HAVB [99 (interquartile range, IQR 97–100)% vs. 72 (IQR 30–99)%, P = 0.02]. Complete recovery (VPP < 1%) was observed in only one patient (2%) with CHB/HAVB. After hospital discharge, no symptomatic bradyarrhythmias or sudden death occurred within 30 days. Patients with pre-existing RBBB exhibited a higher risk of PPMI at 4-year follow-up (26% vs. 8% in non-RBBB patients, P < 0.001). Conclusion In patients with pre-existing RBBB, the vast majority of advanced CDs occurred within the 3 days following TAVR, and most did not recover at 1-month, particularly those with intra-procedural persistent CHB/HAVB. These results should help to determine the hospitalization length and timing of PPMI in RBBB patients undergoing TAVR.

Download Full-text

Abstract 16322: Safety and Efficacy of Transapical Transcatheter Aortic Valve Replacement in the Treatment of Pure Non-calcified Native Aortic Regurgitation

Circulation ◽

10.1161/circ.142.suppl_3.16322 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Can Shen ◽

Ying Peng ◽

Lulu Liu ◽

Jun Shi ◽

Yingqiang Guo ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Heart Valve ◽

Transcatheter Aortic Valve Replacement ◽

Left Ventricular ◽

Paravalvular Leakage ◽

Transcatheter Aortic Valve ◽

Transcatheter Heart Valve

Background: Transcatheter aortic valve replacement (TAVR) in patients with pure aortic regurgitation (AR) is still “off-label” use due to the lack of suitable transcatheter heart valve. This study aimed to evaluate the safety and efficacy of TAVR with J-Valve TM (JieCheng Medical Technology Co., Ltd., Suzhou, China) transcatheter heart valve for the treatment of patients with pure non-calcified native AR. Methods: The clinical and follow-up data of patients with pure non-calcified native AR treated by TAVR with J-Valve TM between April 2014 and November 2019 in the West China Hospital were summarized. Procedural results and clinical outcomes were analyzed using Valve Academic Research Consortium-2 criteria. Results: A total of 123 patients were enrolled with a mean age of 72.1±6.4 years. There were 28 cases with bicuspid aortic valve and 95 cases with trilobal aortic valve. The median follow-up period was 18 months. Transapical implantation with J-Valve TM was successful in all patients (100%). By the end of the follow up, the rate of all-cause mortality was 5.7%, among which 5 cases died during the perioperative period. Other results include stroke (1.6%), new permanent pacemaker implantation (8.9%), major bleeding (6.5%), acute kidney injury (2.4%) and aortic valve-related re-intervention (3.3%, they were given surgical aortic valve replacement for thrombosis of artificial valve (2 cases) or severe post-procedural paravalvular leakage (2 cases)). Among the 112 survival cases without re-intervention, Echocardiography revealed that none of them had moderate or severe paravalvular leakage; mild and mild-moderate paravalvular leakage occurred in 9.8% and 8.0% cases, respectively. Mean transvalvular gradient after valve implantation was 9.2±3.5 mmHg. At 6 months of follow up, left ventricular end diastolic diameter was remarkably smaller compared to that before procedure (53.5±8.2 mm vs 64.3±8.9 mm, P<0.001) and left ventricular ejection fraction was significantly increased (56.3±11.8 % vs 54.2±12.4 %, P=0.031). Conclusions: TAVR with J-Valve TM transcatheter heart valve system for treatment of patients with pure non-calcified native AR is safe and effective which may be a reasonable option in the future treatment.

Download Full-text

Transcatheter aortic valve replacement and His bundle pacing in the presence of severe left ventricular dysfunction and left bundle branch block

Journal of Transcatheter Interventions ◽

10.31160/jotci202129a20210006 ◽

2021 ◽

Vol 29 ◽

pp. 1-4

Author(s):

Luiz São Thiago ◽

Luis Luciano ◽

Aline Tscha ◽

Artur Guimarães ◽

Alice Silva ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Bundle Branch Block ◽

Transcatheter Aortic Valve Replacement ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Bundle Branch Block ◽

Transcatheter Aortic Valve

Aortic stenosis is the most prevalent valve disease in developed countries and has high morbidity and mortality after the onset of symptoms. The prevalence of severe aortic stenosis in elderly patients (>75 years) is approximately 3.4%. The transcatheter aortic valve replacement has been employed for approximately 20 years and had robust outcomes published. However, it is a challenging procedure when performed on a patient in cardiogenic shock, caused by severe deterioration of left ventricular function, a condition aggravated in cases of electromechanical dyssynchrony due to left bundle branch block. There is evidence that reestablishing the electrical conduction with a pacemaker implanted directly in the conduction system, in patients with left ventricular dysfunction and dyssynchrony, can significantly improve the systolic function. In this context, the objective of the present study was to present and discuss the particularities and evidence available for treating this complex subgroup of patients.

Download Full-text

Impact of Conduction Disturbances on Left Ventricular Mass Regression and Remodeling Following Transcatheter Aortic Valve Replacement

10.21203/rs.3.rs-145959/v1 ◽

2021 ◽

Author(s):

Tsung-Yu Ko ◽

Hsien-Li Kao ◽

Ying-Ju Liu ◽

Chih-Fan Yeh ◽

Ching-Chang Huang ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Left Ventricular ◽

Reverse Remodeling ◽

Conduction Disturbances ◽

Transcatheter Aortic Valve ◽

Lv Mass

Abstract Our study aimed to compare the difference of LV mass regression and remodeling in regard of conduction disturbances (CD) following transcatheter aortic valve replacement (TAVR). A prospective analysis of 152 consecutive TAVR patients was performed. 53 patients (34.9%) had CD following TAVR, including 30 (19.7%) permanent pacemaker implantation and 23 (15.2%) new left bundle branch block. In 123 patients with 1-year follow-up, significant improvement of LV ejection fraction (LVEF) (baseline vs 12-month: 65.1±13.2 vs 68.7±9.1, P=0.017) and reduced LV end-systolic volume (LVESV) (39.8±25.8 vs 34.3±17.1, P=0.011) was found in non-CD group (N=85), but not in CD group (N=38). Both groups had significant decrease in LV mass index (baseline vs 12-month: 148.6±36.9 vs. 136.4±34.7 in CD group, p=0.023; 153.0±50.5 vs. 125.6±35.1 in non-CD group, p<0.0001). In 46 patients with 3-year follow-up, only non-CD patients (N=28) had statistically significant decrease in LV mass index (Baseline vs 36-month: 180.8±58.8 vs 129.8±39.1, p=0.0001). Our study showed the improvement of LV systolic function, LV reverse remodeling and mass regression at 1 year could be observed in patients without CD after TAVR. Sustained LV mass regression within 3-year was found only in patients without CD.

Download Full-text