Early Regression of Severe Left Ventricular Hypertrophy After Transcatheter Aortic Valve Replacement Is Associated With Decreased Hospitalizations

• Type of Material: Article
• Authors: Brian R. Lindman, Washington University; William J. Stewart, Cleveland Clinic Foundation; Philippe Pibarot, Laval University; Rebecca T. Hahn, Columbia University; Catherine M. Otto, University of Washington; Ke Xu, Cardiovascular Research Foundation; Richard B. Devereux, Cornell University; Neil J. Weissman, Medstar Health Research Institute; Maurice Enriquez-Sarano, Mayo Clinic; Wilson Y. Szeto, University of Pennsylvania; Raj Makkar, Cedars Sinai Medical Center; D. Craig Miller, Stanford University; Stamatios Lerakis, Emory University; Samir Kapadia, Cleveland Clinic Foundation; Bruce Bowers, Medical City Dallas; Kevin L. Greason, Mayo Clinic; Thomas C. McAndrew, Cardiovascular Research Foundation; Yang Lei, Saint Luke's Mid-America Heart Institute; Martin B. Leon, Columbia University; Pamela S. Douglas, Duke University
• Language: English
• Date: 2014-06-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: ª2014 by the American College of Cardiology Foundation
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jcin.2014.02.011
• Title of Journal or Parent Work: JACC: Cardiovascular Interventions
• ISSN: 1936-8798
• Volume: 7
• Issue: 6
• Start Page: 662
• End Page: 673
• Grant/Funding Information: The present analysis was carried out by academic investigators with no additional funding from Edwards Lifesciences.; The PARTNER Trial was funded by Edwards Lifesciences and the protocol was developed jointly by the sponsor and study steering committee.; Dr. Lindman is supported by K23 HL116660 and the Washington University Institute of Clinical and Translational Sciences grant (UL1 TR000448, KL2 TR000450) from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH).
• Keywords: hospitalizations; Cardiac & Cardiovascular Systems; Science & Technology; SURGERY; SURVIVAL; FIBROSIS; transcatheter aortic valve replacement; hypertrophic left ventricular remodeling; ECHOCARDIOGRAPHY; STENTLESS; STENOSIS; MASS REGRESSION; IMPACT; heart failure; INDEX; Cardiovascular System & Cardiology; Life Sciences & Biomedicine; aortic stenosis
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Objectives This study sought to examine the relationship between left ventricular mass (LVM) regression and clinical outcomes after transcatheter aortic valve replacement (TAVR). Background LVM regression after valve replacement for aortic stenosis is assumed to be a favorable effect of LV unloading, but its relationship to improved clinical outcomes is unclear. Methods Of 2,115 patients with symptomatic aortic stenosis at high surgical risk receiving TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) randomized trial or continued access registry, 690 had both severe LV hypertrophy (left ventricular mass index [LVMi] 149 g/m2 men, 122 g/m2 women) at baseline and an LVMi measurement at 30-day post-TAVR follow-up. Clinical outcomes were compared for patients with greater than versus lesser than median percentage change in LVMi between baseline and 30 days using Cox proportional hazard models to evaluate event rates from 30 to 365 days. Results Compared with patients with lesser regression, patients with greater LVMi regression had a similar rate of all-cause mortality (14.1% vs. 14.3%, p = 0.99), but a lower rate of rehospitalization (9.5% vs. 18.5%, hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.32 to 0.78; p = 0.002) and a lower rate of rehospitalization specifically for heart failure (7.3% vs. 13.6%, p = 0.01). The association with a lower rate of rehospitalization was consistent across subgroups and remained significant after multivariable adjustment (HR: 0.53, 95% CI: 0.34 to 0.84; p = 0.007). Patients with greater LVMi regression had lower B-type natriuretic peptide (p = 0.002) and a trend toward better quality of life (p = 0.06) at 1-year follow-up than did those with lesser regression. Conclusions In high-risk patients with severe aortic stenosis and severe LV hypertrophy undergoing TAVR, those with greater early LVM regression had one-half the rate of rehospitalization over the subsequent year compared to those with lesser regression.