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Transcatheter Aortic Valve Replacement and Left Ventricular Geometry: Survival and Gender Differences
Vien T Truong1, Wojciech Mazur2, John Broderick2
1The Heart and Vascular Center and The Lindner Research Center, The Christ Hospital Health Network, Cincinnati, Ohio; The Sue and Bill Butler Research Fellow, The Lindner Research Center, Cincinnati, Ohio.
Insights
Baseline concentric hypertrophy offers a survival advantage in patients undergoing transcatheter aortic valve replacement (TAVR). This finding highlights the importance of left ventricular (LV) geometry in predicting TAVR outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Transcatheter aortic valve replacement (TAVR) is a key treatment for aortic stenosis.
- Left ventricular (LV) geometry is a crucial determinant of cardiac function.
- Understanding the impact of LV geometry on TAVR outcomes is essential for patient stratification.
Purpose of the Study:
- To investigate the association between baseline left ventricular (LV) geometry and patient outcomes following transcatheter aortic valve replacement (TAVR).
- To determine if specific LV geometry patterns predict survival rates after TAVR.
Main Methods:
- Classified baseline LV geometry in 206 TAVR patients into four types: concentric hypertrophy, eccentric hypertrophy, concentric remodeling, and normal.
- Employed descriptive statistics, Kaplan-Meier survival analysis, and Cox regression to analyze data.
- Examined gender differences in LV geometry distribution at baseline and post-TAVR.
Main Results:
- Baseline LV geometry distribution differed significantly between males and females, but this difference diminished by 1 year post-TAVR.
- Patients with concentric hypertrophy often transitioned to concentric remodeling after TAVR.
- Survival rates at 1 year and 6.5 years post-TAVR varied significantly across different LV geometry groups.
- Concentric hypertrophy was associated with a survival advantage compared to normal geometry and concentric remodeling, which had higher all-cause mortality rates.
Conclusions:
- Baseline concentric hypertrophy is linked to improved survival after TAVR.
- While initial LV geometry patterns may be gender-specific, these distinctions are not sustained long-term post-TAVR.
- LV geometry is an important prognostic factor in patients undergoing TAVR.
Background:
The aim of this study was to examine the relationship between baseline left ventricular (LV) geometry and outcomes after transcatheter aortic valve replacement (TAVR).
Methods:
Patients undergoing TAVR (n = 206) had baseline LV geometry classified as (1) concentric hypertrophy, (2) eccentric hypertrophy, (3) concentric remodeling, or (4) normal. Descriptive statistics, Kaplan-Meier time-to-event analysis, and Cox regression were performed.
Results:
Distribution of baseline LV geometry differed between male and female patients (χ2 = 16.83, P = .001) but not at 1 month (χ2 = 2.56, P = .47) or 1 year (χ2 = 5.68, P = .13). After TAVR, a majority of patients with concentric hypertrophy evolved to concentric remodeling. Survival differed across LV geometry groups at 1 year (χ2[3] = 8.108, P = .044, log-rank test) and at 6.5 years (χ2[3] = 9.023, P = .029, log-rank test). Compared with patients with concentric hypertrophy, patients with normal geometry (hazard ratio, 2.25; 95% CI, 1.12-4.54; P = .023) and concentric remodeling (hazard ratio, 1.89; 95% CI, 1.12-3.17; P = .016) had higher rates of all-cause mortality.
Conclusions:
Baseline concentric hypertrophy confers a survival advantage after TAVR. Although baseline patterns of LV geometry appear gender specific (with women demonstrating more concentric hypertrophy), this difference resolves after TAVR.
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