Impact of transcatheter aortic valve replacement on left ventricular hypertrophy, diastolic dysfunction and quality of life in patients with preserved left ventricular function

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Medical Imaging

Background:

• Severe aortic stenosis (AS) often causes left ventricular (LV) hypertrophy and diastolic dysfunction (LVDD).
• Transcatheter aortic valve replacement (TAVR) aims to improve hemodynamics, LV remodeling, LVDD, and heart failure (HF)-related quality of life (QoL).

Purpose of the Study:

• To evaluate the impact of TAVR on LV remodeling, diastolic function, and QoL in patients with severe AS and preserved ejection fraction.
• To identify predictors of reverse LV remodeling after TAVR.

Main Methods:

• Retrospective analysis of 171 patients with severe AS and LV ejection fraction (LVEF) ≥50% who underwent TAVR.
• Transthoracic echocardiograms pre-procedure, and at 1 month and 1 year post-TAVR to assess LV volumes and diastolic function.
• Kansas City Cardiomyopathy Questionnaire (KCCQ) used for QoL assessment.

Main Results:

• Significant improvements in LV mass index (LVMI), LV end-systolic diameter, and LV end-diastolic diameter were observed from baseline to 1 year post-TAVR.
• Predictors of LVMI regression included improved mean aortic valve (AV) gradient, peak AV velocity, and septal/lateral e' and E/e' velocities.
• The prevalence of grade ≥2 LVDD decreased from 65% at baseline to 49% at 1 year post-TAVR.
• Significant improvement in KCCQ scores indicated enhanced QoL.

Conclusions:

• TAVR promotes reverse LV remodeling, evidenced by reduced LVMI and improved diastolic function, persisting up to one year post-procedure.
• Improvements in hemodynamic parameters (AV gradient, velocities) are key drivers of reverse LV remodeling.
• TAVR is associated with significant improvements in LVDD and HF-related QoL.