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Left ventricular hypertrophy as a predictor of cardiovascular outcomes after transcatheter aortic valve replacement

Nobuyasu Ito1, Kan Zen1, Motoyoshi Takahara1

  • 1Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

ESC Heart Failure
|February 1, 2023
PubMed

Insights

Severe left ventricular hypertrophy (LVH) before transcatheter aortic valve replacement (TAVR) predicts worse cardiovascular outcomes. Cardiac sympathetic nerve function, assessed by MIBG scintigraphy, is linked to LVH and prognosis after TAVR.

Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Cardiovascular Imaging

Background:

  • Severe aortic stenosis is a significant cause of cardiovascular morbidity.
  • Left ventricular hypertrophy (LVH) is a common complication of aortic stenosis.
  • The prognostic implications of LVH and cardiac sympathetic nerve (CSN) function in patients undergoing TAVR require further elucidation.

Purpose of the Study:

  • To investigate the relationship between pre-operative severe LVH and cardiovascular prognosis in patients undergoing TAVR.
  • To assess the association between CSN function, evaluated using 123I-metaiodobenzylguanidine (MIBG) scintigraphy, and LVH in this patient cohort.
  • To explore the correlation between changes in LVH and CSN function post-TAVR.

Main Methods:

  • A retrospective observational study of 349 patients who underwent TAVR.
  • Patients were stratified into severe LVH (+) and severe LVH (-) groups based on pre-operative assessment.
  • Cardiovascular events, left ventricular mass index (LVMi), and MIBG heart-to-mediastinum (H/M) ratios were analyzed pre- and post-TAVR.

Main Results:

  • The severe LVH (+) group had a significantly lower rate of freedom from cardiovascular events (87.1% vs. 96.0%).
  • Pre-operative severe LVH was associated with lower MIBG H/M ratios (2.33 vs. 2.67), indicating impaired CSN function.
  • Post-TAVR, patients with improved LVH showed increased MIBG H/M ratios, while those without improvement had no significant change.

Conclusions:

  • Pre-operative severe LVH is a significant predictor of adverse cardiovascular outcomes following TAVR.
  • Impaired cardiac sympathetic nerve function is correlated with LVH in severe aortic stenosis patients.
  • These findings suggest that LVH and CSN function play a role in the cardiovascular prognosis after TAVR.
Abstract

Keywords:
123I-Metaiodobenzylguanidine scintigraphyAortic stenosisCardiac sympathetic nerve functionLeft ventricular hypertrophyTranscatheter aortic valve replacement

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