Reverse Cardiac Remodeling after Transcatheter Aortic Valve Replacement in Patients with Low-Flow Low-Gradient Aortic Stenosis, Differences between Self-Expandable and Balloon-Expandable Valves

Abstract

Objective: To investigate reverse cardiac remodeling in self-expandable valve (SEV) and balloon-expandable valve (BEV) in patients with low-flow, low-gradient aortic stenosis (LFLGAS) who performed transcatheter aortic valve replacement (TAVR).

Methods: Patients with classical low-flow, low-gradient aortic stenosis (CLFLGAS) and paradoxical low-flow, low-gradient aortic stenosis (PLFLGAS) after TAVR from the Optimized transCathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation registry were analyzed. The baseline characteristics, transthoracic echocardiographic data, and outcomes were examined in the SEV and BEV groups for each low gradient type. Echocardiography was performed at baseline and 1 year after TAVR. In this study, reverse cardiac remodeling was defined as both of increase in left ventricular ejection fraction (LVEF) ≥10% and reduction in left ventricular mass index (LVMi) ≥10% at 1 year.

Results: Among 163 patients with LFLGAS, 95 patients had CLFLGAS and 68 patients had PLFLGAS. LVEF in patients with CLFLGAS significantly improved 1 year after TAVR in both the SEV and BEV groups (SEV group, baseline: 36.6% [interquartile range {IQR} 28.6%–46.3%] vs. 1 year: 56.0% [IQR 42.0%–67.1%], p = 0.006; BEV group, baseline: 36.0% [IQR 30.5%–44.1%] vs. 1 year: 57.4% [IQR 41.0%–63.5%], p <0.001). LVEF in patients with PLFLGAS did not improve 1 year after TAVR in both valves. LVMi in patients with CLFLGAS significantly decreased 1 year after TAVR in both valves. (SEV group, baseline: 146.4 g/m² [IQR 110.7 g/m²–180.2 g/m²] vs. 1 year: 56.0 g/m² [IQR 42.0 g/m²–67.1 g/m²], p = 0.028; BEV group, baseline: 132.5 g/m² [IQR 120.3 g/m²–161.3 g/m²] vs. 1 year: 122.6 g/m² (standard deviation ± 34.7 g/m²), p = 0.004). LVMi in patients with PLFLGAS did not improve 1 year after TAVR in both valves. The rates of reverse cardiac remodeling in patients with CLFLGAS were significantly higher than those in patients with PLFLGAS (47.8% vs. 9.1%, p <0.001). There was no significant difference in reverse cardiac remodeling rates between SEV and BEV in patients with CLFLGAS and PLFLGAS. (CLFLGAS, 54.5% vs. 45.7%, p = 0.609; PLFLGAS, 28.6% vs. 5.4%, p = 0.113).

Conclusions: Reverse cardiac remodeling was more observed after TAVR among patients with CLFLGAS than those with PLFLGAS. The valve type did not affect the rates of reverse cardiac remodeling after TAVR in each LFLG type.