Outcome of Left-Sided Cardiac Remodeling in Severe Aortic Stenosis Patients Undergoing Transcatheter Aortic Valve Implantation

Abstract

Left-sided cardiac remodeling in patients with severe aortic stenosis (AS) was associated with improved outcome; however, there are scarce data on remodeling process after transcatheter aortic valve implantation (TAVI). We sought to describe the remodeling process in patients with severe AS who underwent TAVI. Echocardiographic data were systematically collected at baseline, 30 days, 6 months, and 1 year, from a cohort of 333 patients who underwent TAVI. Patients were categorized according to left ventricular mass index (LVMi) and relative wall thickness (RWT) to the following geometries: (1) normal; (2) concentric remodeling; (3) concentric hypertrophy; and (4) eccentric hypertrophy. Reverse remodeling (partial or complete) was defined as normalization of LVMi and/or RWT and adverse remodeling as an increase in LVMi and/or RWT. The longitudinal change in LVMi and left atrial diameter index (LADi) was assessed using mixed models. Reverse LV remodeling at 1-year was observed in 24% of patients with available echo at follow-up, whereas 17% of patients had adverse remodeling at 1-year follow-up. This was especially noted in patients with normal geometry at baseline. Interestingly, LV reverse remodeling was not accompanied by a reduction in left atrial diameter. In conclusion, TAVI reverse ventricular remodeling and LV hypertrophy induced by aortic stenosis; however, this reversal is incomplete in most patients at 1-year and not followed by change in left atrial dimensions. Whether this favorable remodeling may impact clinical outcome needs to be further elucidated.