Pre-TAVI volumetric analysis for predicting LVEF improvement following TAVI

Introduction:

Patients with severe aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF) have significantly worse clinical outcomes. Trans-arterial valvular implantation (TAVI) has become the procedure of choice for severe AS in patient with intermediate or high surgical risk. Degree of improvement of LVEF Following TAVI is variable.

The objective of our study was to correlate pre-TAVI CT volumetric analysis with LVEF improvement following TAVI.

Material and methods:

A consecutive cohort of patients with severe AS and LVEF <40% who underwent TAVI at our institution. All patients underwent pre-TAVI CT volumetric analysis reconstructed every 10% of the R-R interval. From these: systolic, mid-diastolic, and late-diastolic ventricular and atrial volume changes were derived. Follow-up TTE was performed within 3 months in all patients. An improvement ≥10% in LVEF was considered significant.

Results and discussion:

We included 103 patients (mean age 79 (51-102) years, 75.7% male). Median LVEF prior to TAVI was 35% (range 10-40%). Significant improvement in LVEF was observed in 30.1% following TAVI. Left and right ventricular and atrial volumes were similar between patients with and without improvement in LVEF. Patients who improved had numerically greater resting LVEF compared with patients who did not improve (36.9±2.1% vs 33.3±1.2%, p=0.13). Patients with moderately reduced LVEF at baseline (30-40%) improved their LVEF by 6.16% compared with 5.9% in patients with severe baseline LVEF (<30%) (p=0.89).

Conclusion:

Initial volumetric findings suggest that ventricular and atrial volumes are similar between patients who demonstrate improvement in LVEF following TAVI compared with those who do not. Lower baseline LVEF is not associated with lesser degrees of improvement in LVEF.