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Flow Normalization and Left Ventricular Ejection Fraction Improvement After Transcatheter Aortic Valve Replacement
Chisom Enwere1, Roya Anahita Mousavi2, Pragati Basera3
1Department of Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York.
The American Journal of Cardiology
|May 31, 2026
Summary
Flow normalization after TAVR is similar across low-flow aortic stenosis subtypes. Left ventricular ejection fraction improvement is most common in low-flow, low-gradient AS with reduced ejection fraction, but changes are often discordant.
Area of Science:
- Cardiology
- Interventional Cardiology
- Echocardiography
Background:
- Low-flow aortic stenosis (AS) is a high-risk subgroup of severe AS.
- Left ventricular ejection fraction (LVEF) and stroke volume index (SVi) changes after TAVR impact outcomes.
- Understanding these changes across AS subtypes is crucial.
Purpose of the Study:
- Evaluate flow normalization and LVEF improvement in low-flow AS subtypes post-TAVR.
- Assess the concordance of these improvements.
- Identify predictors for flow normalization and LVEF improvement.
Main Methods:
- Patients with severe low-flow AS (SVi <35 mL/m²) undergoing TAVR were classified.
- Subtypes included low-flow, low-gradient AS with reduced or preserved LVEF, and low-flow, high-gradient AS.
- Echocardiography at 1 year assessed flow normalization and LVEF improvement (≥5%).
Main Results:
- Flow normalization occurred similarly across all low-flow AS subtypes (38.5% overall).
- LVEF improvement (≥5%) was most frequent in LFLG AS with reduced LVEF (65.6%).
- Concordant improvement was observed in only 16% of patients; lower baseline LVEF predicted LVEF improvement.
Conclusions:
- Flow normalization rates are comparable across low-flow AS subtypes post-TAVR.
- LVEF improvement is most prominent in low-flow, low-gradient AS with reduced LVEF.
- Improvements in flow and LVEF frequently occur discordantly, with unclear prognostic significance.
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