1Pál Maurovich-Horvat MD PhD MPH, 1Bálint Szilveszter MD PhD, 1Daniel Oren, 1Márton Kolossváry MD, 1Borbála Vattay, 1Júlia Karády MD, 1Andrea Bartykowszki MD, 2Ferenc Suhai MD, 1Ádám L. Jermendy MD, 2Alexisz Panajotu MD, 2Anikó I. Nagy MD PhD, 2Apor Astrid MD, 2Béla Merkely MD PhD DSc
1MTA-SE Cardiovascular Imaging Research Group, Semmelweis University, Budapest
2Heart and Vascular Center, Semmelweis University, Budapest, Hungary
Introduction: Aortic valve stenosis (AS) causes pressure overload to the left ventricle (LV), resulting in LV hypertrophy and remodeling. Transcatheter aortic valve implantation (TAVI) has rapidly emerged as a safe and effective treatment alternative for intermediate to high risk patients with severe AS. Reverse remodeling after TAVI might improve patients' prognosis and functional status.
Aims: We aimed to evaluate the impact of TAVI on LV remodeling as measured by CT angiography. Furthermore, we sought to assess independent predictors of reverse remodeling, including hypo-attenuated leaflet thickening (HALT) as detected on follow-up CT images.
Methods: We performed 256-slice CT angiography for TAVI planning and follow-up. We measured LV mass on serial CT images based on epi- and endocardial contours. Reverse remodeling was defined as reduction in LV mass. HALT was evaluated using a consensus read of 3 experienced radiologists. We recorded patients' risk factors along with echocardiographic and CT characteristics. Multivariate linear regression analysis was performed to identify the independent predictors of reverse remodeling.
Results: A total of 80 patients were included in our study. We found significant reduction in LV mass index after TAVR procedure: 102.3 (80.4-121.6) grams/m2 for pre- and 74.5 (62.1-87.7) grams/m2 for post-TAVR, respectively, p<0.001. More than 20% reduction in LV mass was found in 66% of the patients. Using multivariate linear regression analysis we found that HALT was an independent factor of LV remodeling over age, gender, paravalvular leak and traditional risk factors (hypertension, dyslipidemia, BMI and diabetes mellitus): Beta coefficient -16.4, p=0.040. Change in NYHA class (pre- and post TAVR) was not associated with the change of LV mass after TAVR (p=0.232).
Conclusions: Significant regression of LV mass was observed after TAVR procedure. HALT was an independent predictor of reverse remodeling and showed an inverse association with beneficial structural changes
Doctoral School: Basic and Translational Medicine
Program: Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
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