Left ventricular systolic recovery after TAVI in severe aortic stenosis: A systematic review and meta-analysis

Severe aortic stenosis (AS) imposes chronic pressure overload on the left ventricle (LV), leading to adverse remodeling and systolic dysfunction. While transcatheter aortic valve implantation (TAVI) can reverse this process, the overall prevalence and predictors of LV functional recovery are not fully understood. This study aims to assess the left ventricular ejection fraction (LVEF) recovery following TAVI.

A meta-analysis was conducted in accordance with PRISMA guidelines. The PubMed, Scopus, Web of Science, and Cochrane databases were searched from inception through November 2024 for studies reporting on LVEF improvement after TAVI in patients with severe AS. The primary outcome was LVEF improvement, defined as an absolute increase of ≥10% from baseline. A random-effects model was employed for all pooled analyses to account for inter-study heterogeneity.

Eighteen studies encompassing 4782 patients met the inclusion criteria. In the subgroup of patients with reduced LVEF, 14 studies with a total of 3182 patients reported a LV systolic recovery of 49% (95% CI: 40-57; I2 = 97%). The recovery was observed across all follow-up periods, from immediately post-procedure to one-year. A meta-regression has identified that baseline LVEF is a predictor of LV systolic recovery (β = -0.042 (95% CI: [-0.075, -0.008], p = 0.018, I2 = 93.31%).

TAVI is associated with substantial LV systolic recovery in nearly half of all patients with pre-existing systolic dysfunction. These findings underscore the prognostic importance of myocardial recovery in this high-risk patient population and can inform clinical decision-making and patient counseling.