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Regression of Left Ventricular Mass After Transcatheter Aortic Valve Replacement: The PARTNER Trials and Registries

Katherine H Chau1, Pamela S Douglas2, Philippe Pibarot3

  • 1Cardiovascular Research Foundation, New York, New York; Structural Heart and Valve Center, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York.

Journal of the American College of Cardiology
|May 16, 2020
PubMed

Insights

Greater regression of left ventricular mass index (LVMi) after transcatheter aortic valve replacement (TAVR) is linked to better long-term survival and fewer hospitalizations. This suggests LVMi regression is a key indicator for TAVR patient outcomes.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Imaging

Background:

  • Left ventricular mass index (LVMi) regression after transcatheter aortic valve replacement (TAVR) is linked to improved short-term outcomes.
  • However, the association between LVMi regression and longer-term clinical results following TAVR remains unclear.

Purpose of the Study:

  • To investigate the relationship between LVMi regression at one year post-TAVR and clinical outcomes observed between one and five years.
  • To assess the prognostic value of LVMi changes in patients undergoing TAVR.

Main Methods:

  • Analysis of intermediate- and high-risk patients from the PARTNER trials/registries who underwent TAVR.
  • Inclusion criteria: alive at 1 year post-TAVR, baseline moderate/severe left ventricular hypertrophy (LVH), and paired LVMi measurements at baseline and 1 year.
  • Statistical examination of associations between LVMi regression (percent change from baseline to 1 year) and all-cause death or rehospitalization from 1 to 5 years.

Main Results:

  • Greater LVMi regression at 1 year was significantly associated with lower rates of all-cause death (aHR: 0.95 per 10% decrease; p=0.004).
  • Patients with the greatest LVMi regression showed a 39% lower risk of death compared to those with the least regression (aHR: 0.61; p=0.005).
  • Severe LVH at 1 year was an independent predictor of increased all-cause death (aHR: 1.71; p=0.003), with similar findings for cardiovascular mortality and rehospitalization.

Conclusions:

  • In TAVR patients with moderate/severe LVH alive at 1 year, substantial LVMi regression predicts reduced mortality and hospitalization rates up to 5 years.
  • These findings highlight the importance of LVMi regression as a prognostic marker post-TAVR.
  • The results may inform decisions regarding the timing of valve replacement and the use of additional medical therapies.
Abstract

Keywords:
aortic stenosishospitalizationleft ventricular hypertrophyleft ventricular mass regressionmortalitytranscatheter aortic valve replacement

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