Original title: Early Regression of Severe Left Ventricular Hypertrophy After Transcatheter Aortic Valve Replacement Is Associated with Decreased Hospitalization. Reference: Brian Lindman, et al. JACC Cardiovasc Interv 2014;7:662-73.
Left ventricular hypertrophy, defined by the increase of left ventricular mass, has long been associated to increased morbi-mortality in the context of different heart conditions. LV hypertrophy regression might improve clinical outcomes.
This study analyzed 690 cohort A patients from the Partner trial (137 randomized and 553 from the registry). Patients presenting severe left ventricular hypertrophy were included (left ventricular mass index ≥149 g/m2 in men and ≥122 g/m2 in women).
Primary end point was a combination of all cause death, cardiac death, re hospitalization, stroke, renal failure, major bleeding, infarction and vascular complications. Mean population age was 85, aortic valve area, 0.65 cm2 and STS was 11.
At one year follow up, LV hypertrophy decreased from 166±31 g/m2 at baseline to 137±35 g/m2 (p<0.001), especially in women. No differences were observed from baseline ECG.
In more than half of the population regression was observed within 30 days after procedure. Those with lesser early regression were often obese and required definite pacemaker. After TAVI, those with greater regression had smaller VMI diameter and less wall thickness.
At 30 days and 12 month follow up there were no differences in all-cause mortality rates, but there was a lower re hospitalization rate for cardiac failure among those with greater early regression of VMI and this advantage was maintained throughout follow up period.
Functional class and 6 minute walk test were similar, but those presenting early regression evolved with better quality of life and lower natriuretic peptide values.
Conclusion
In patients with severe aortic stenosis and severe left ventricular hypertrophy receiving transcatheter aortic valve replacement, greater early regression of VM was associated with decreased re hospitalization compared to patients with lesser regression.
Commentary
Half LVMI cases happen within the first 30 days after procedure and last 12 months, which proves heart plasticity. This is associated to a lower re hospitalization rate and a better quality of life without affecting mortality.
Courtesy of Dr. Carlos Fava
Interventional Cardiologist
Favaloro Fundation
Buenos Aires – Argentina
Dr. Carlos Fava para SOLACI.ORG
