Background: The increase in left ventricle (LV) wall thickness and in LV diameter (both components of LV mass) is a remodeling process aimed to compensate LV against chronic pressure overload such as severe aortic stenosis (AS). However, this compensatory process is often associated with unfavorable prognosis.
We aimed to assess the regression of LV mass 6-12 months post transcatheter aortic valve implantation (TAVI) and its impact on functional class.
Methods:We analyzed retrospectively the indexed LV mass (LVMi) calculated by echocardiography at baseline as compared to 6-12 months post TAVI. Functional class data (NYHA classification) was obtained from the medical records.
Results: 134 patients were included in the analysis. There was a significant reduction in LVMi (mean reduction of 10.5 gr (CI 6.22-14.78, p<0.001); 59% of patients had a decrease greater than 5% in LVMi, 17.2% had no significant change in LVMi and 23.9% had an increase of LVMi. There was a reduction in intraventricular septum (IVS) and the left posterior wall thickness (LVPW) (0.6
+2 mm, p=0.01 and 0.7
+19 mm, p<0.001 respectively). However, there was no significant change in the LV end diastolic diameter (LVEDD). We did not detect associations between LV mass reduction and age, gender, systolic LV function, pre-TAVI transvalvular gradients, aortic regurgitation or mitral regurgitation at baseline, renal function, hypertension, DM, dyslipidemia and medical treatment except for aspirin. Interestingly, we did not demonstrate a positive correlation between LVMi reduction and NYHA functional class at 6 and 12 months.
Conclusion: Most patients had a significant regression in LVMi 6-12 months post TAVI secondary to a reduction in the IVS and LVPW thickness. However, this regression was not linked to the improvement in functional class. Further study is needed to examine the practical impact of LVMi reduction in this subpopulation of patients with severe symptomatic AS.
