Transcatheter Aortic Valve Replacement and Left Ventricular Geometry: Survival and Gender Differences

J Am Soc Echocardiogr. 2020 Nov;33(11):1357-1362.e2. doi: 10.1016/j.echo.2020.06.015. Epub 2020 Aug 20.

Abstract

Background: The aim of this study was to examine the relationship between baseline left ventricular (LV) geometry and outcomes after transcatheter aortic valve replacement (TAVR).

Methods: Patients undergoing TAVR (n = 206) had baseline LV geometry classified as (1) concentric hypertrophy, (2) eccentric hypertrophy, (3) concentric remodeling, or (4) normal. Descriptive statistics, Kaplan-Meier time-to-event analysis, and Cox regression were performed.

Results: Distribution of baseline LV geometry differed between male and female patients (χ2 = 16.83, P = .001) but not at 1 month (χ2 = 2.56, P = .47) or 1 year (χ2 = 5.68, P = .13). After TAVR, a majority of patients with concentric hypertrophy evolved to concentric remodeling. Survival differed across LV geometry groups at 1 year (χ2[3] = 8.108, P = .044, log-rank test) and at 6.5 years (χ2[3] = 9.023, P = .029, log-rank test). Compared with patients with concentric hypertrophy, patients with normal geometry (hazard ratio, 2.25; 95% CI, 1.12-4.54; P = .023) and concentric remodeling (hazard ratio, 1.89; 95% CI, 1.12-3.17; P = .016) had higher rates of all-cause mortality.

Conclusions: Baseline concentric hypertrophy confers a survival advantage after TAVR. Although baseline patterns of LV geometry appear gender specific (with women demonstrating more concentric hypertrophy), this difference resolves after TAVR.

Keywords: Hospitalization; LV geometry; Mortality; TAVR.

MeSH terms

  • Aortic Valve / surgery
  • Aortic Valve Stenosis* / diagnosis
  • Aortic Valve Stenosis* / surgery
  • Female
  • Humans
  • Hypertrophy, Left Ventricular / diagnostic imaging
  • Male
  • Risk Factors
  • Sex Factors
  • Transcatheter Aortic Valve Replacement*
  • Ventricular Function, Left
  • Ventricular Remodeling