left ventricular remodeling post transcatheter aoric valve implantation- prospective one year follow up of single medical center

For almost two decades, Transcatheter Aortic Valve Implantation (TAVI) has been the most effective treatment for degenerative aortic stenosis (AS). Most often, patients with a clinical indication for TAVI present with numerous cardiovascular problems, which might hinder potential post-TAVI recovery. While there is no doubt that most patients undergoing TAVI benefit from an overall improvement in their cardiac hemodynamic - particularly regression in left ventricle hypertrophy, some experience worsening in left ventricle hypotrophy. We conducted a retrospective study in a tertiary medical center in central Israel which aimed to identify possible predicting factors leading to that worsening. Echocardiogram data (LVMI, LVEDD, PW/IVS, RWT, LVEF, PAP) from 95 patients were collected prior to TAVI in three time periods in the year following the procedure (1, 6, and 12 months). The effect of TAVI on the progression or regression of the hypertrophy was estimated, in part, by the Left Ventricular Mass Index (LVMI). Our data show that, compared with non-hypertensive patients, a significant increase in LVMI was observed in hypertensive patients post- TAVI; 55% of the hypertensive group showed an increase in LVMI, compared with only 10% on non-hypertensive patient (p=0.011). Surprisingly, atrial fibrillation was shown to be protective against an increase in LVMI; 21% of patients with atrial fibrillation were showed an increase in LVMI while 50% of the patients without it did not (p=0.04). Our findings, although derived from a small group of patients, are of significant clinical importance as hypertension and atrial fibrillation are prevalent in many patients who undergo TAVI (80% and 40% respectively in our group). We believe that the implications of our results should be taken into consideration, especially when deciding to preform TAVI in hypertensive patients. Deciding to preform TAVI earlier in hypertensive patients might even be clinically beneficial by preventing the cardiac remodeling imposed by the evolving cardiomyopathy in those patients.