Related Experiment Video
Updated: Oct 16, 2026
Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement
Published on: January 20, 2022
Pre-Procedural Prediction of Left Ventricular Ejection Fraction Normalization After Transcatheter Aortic Valve
Yuki Hida1, Teruhiko Imamura1, Hiroshi Ueno1
1Department of Cardiology, Toyama University Hospital, Toyama, Japan.
Background:
Transcatheter aortic valve implantation (TAVI) is an established therapy for severe aortic stenosis. Among patients with left ventricular (LV) systolic dysfunction, recovery of LV function after TAVI is heterogeneous, and reliable tools for pre-procedural risk stratification and patient counseling remain limited.
Aims:
We sought to identify simple pre-procedural predictors of complete LV functional recovery after TAVI and to develop a clinically applicable risk score to support patient counseling and post-procedural management.
Methods:
We retrospectively analyzed patients with severe aortic stenosis and baseline LV ejection fraction (LVEF) < 40% enrolled in a large multicenter registry in Japan. The primary outcome was complete LVEF normalization (LVEF > 50%) at 1 year after TAVI. Independent predictors were identified using multivariable logistic regression in a derivation cohort, and an exploratory weighted score was constructed. The score was preliminarily assessed in a separate single-center cohort.
Results:
The derivation cohort comprised 177 patients (median age 84 years; 44% women), of whom 94 (53%) achieved LVEF normalization. Lower body mass index (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.77-0.95; p = 0.004), higher aortic valve peak velocity (OR 2.45, 95% CI 1.40-4.29; p = 0.002), and smaller LV end-diastolic diameter (OR 0.93, 95% CI 0.88-0.98; p = 0.020) were independently associated with LVEF normalization. The derived score stratified patients into low-, intermediate-, and high-probability groups (15%, 45%, and 71%, respectively; p < 0.001), with consistent discrimination in the validation cohort.
Conclusions:
A simple exploratory score incorporating body mass index, transvalvular peak velocity, and LV size was associated with the probability of complete LV functional recovery after TAVI. This pre-procedural tool may facilitate patient counseling, expectation-setting, and identification of patients who may require closer heart failure follow-up after TAVI. It should not be used to determine eligibility for TAVI.
