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Regression of Left Ventricular Mass After Transcatheter Aortic Valve Replacement: The PARTNER Trials and Registries.

by Asch, Federico M; Weissman, Neil J.
Citation: Journal of the American College of Cardiology. 75(19):2446-2458, 2020 05 19.; .Journal: Journal of the American College of Cardiology.Published: 2020; ; ; ISSN: 0735-1097.Full author list: Alu MC; Asch FM; Chau KH; Clavel MA; Cremer P; Daubert M; Douglas PS; Elmariah S; Gertz ZM; Hahn RT; Jaber WA; Khalique OK; Leon MB; Lindman BR; Pibarot P; Thourani VH; Weissman NJ; Zhang Y.UI/PMID: 32408979.Subject(s): *Aortic Valve Stenosis/dg [Diagnostic Imaging] | *Aortic Valve Stenosis/su [Surgery] | *Hypertrophy, Left Ventricular/dg [Diagnostic Imaging] | *Registries | *Transcatheter Aortic Valve Replacement/td [Trends] | Aged | Aged, 80 and over | Aortic Valve Stenosis/mo [Mortality] | Female | Humans | Hypertrophy, Left Ventricular/mo [Mortality] | Male | Mortality/td [Trends] | Transcatheter Aortic Valve Replacement/mo [Mortality] | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: (Click here) Abbreviated citation: J Am Coll Cardiol. 75(19):2446-2458, 2020 05 19; .Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007.Abstract: BACKGROUND: Greater early left ventricular mass index (LVMi) regression is associated with fewer hospitalizations 1 year after transcatheter aortic valve replacement (TAVR). The association between LVMi regression and longer-term post-TAVR outcomes is unclear.Abstract: CONCLUSIONS: Among patients with moderate or severe LVH treated with TAVR who are alive at 1 year, greater LVMi regression at 1 year is associated with lower death and hospitalization rates to 5 years. These findings may have implications for the timing of valve replacement and the role of adjunctive medical therapy after TAVR. Copyright (c) 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.Abstract: METHODS: Among intermediate- and high-risk patients who received TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) I, II, and S3 trials or registries and were alive at 1 year, we included patients with baseline moderate or severe left ventricular hypertrophy (LVH) and paired measurements of LVMi at baseline and 1 year. The associations between LVMi regression (percent change between baseline and 1 year) and death or rehospitalization from 1 to 5 years were examined.Abstract: OBJECTIVES: The purpose of this study was to determine the association between LVMi regression at 1-year post-TAVR and clinical outcomes between 1 and 5 years.Abstract: RESULTS: Among 1,434 patients, LVMi was 146 g/m2 (interquartile range [IQR]: 133 to 168 g/m2) at baseline and decreased 14.5% (IQR: 4.2% to 26.1%) to 126 g/m2 (IQR: 106 to 148 g/m2) at 1 year. After adjustment, greater LVMi regression at 1 year was associated with lower all-cause death (adjusted hazard ratio [aHR]: 0.95 per 10% decrease in LVMi; 95% confidence interval [CI]: 0.91 to 0.98; p = 0.004; aHR of the quartile with greatest vs. least LVMi regression: 0.61; 95% CI: 0.43 to 0.86; p = 0.005). Severe LVH at 1 year was observed in 39%, which was independently associated with increased all-cause death (aHR of severe LVH vs. no LVH: 1.71; 95% CI: 1.20 to 2.44; p = 0.003). Similar associations were found for rates of cardiovascular mortality and rehospitalization.

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