Influence of early left ventricular end-diastolic diameter improvement on prognosis of severe aortic valve stenosis patients after transcatheter aortic valve replacement

Abstract

Objective To investigate the early changes of left ventricular end-diastolic diameter (LVEDD) in patients with severe aortic valve stenosis (AS) after transcatheter aortic valve replacement (TAVR) and the effect of the changes on the prognosis of TAVR. Methods A single-center retrospective cohort study was performed on 113 severe AS patients undergoing TAVR treatment in our hospital from December 2017 to December 2021.When the improvement of postoperative to preoperative LVEDD ≥1.8 mm was defined as early LVEDD improvement by echocardiography, the patients were divided into improvement group and non-improvement group.After the patients were followed up in 1 year after TAVR through clinic or telephone visits, their clinical data on cardiac ultrasound, electrocardiogram, and surgery-related complications were collected.The endpoints were major adverse cardiovascular events (MACE), including 1-year all-cause mortality, myocardial infarction or angina, and heart failure-related hospitalization. Results The average age of the patients was 71.2±6.5 years, and 59(52.2%) of them were female.The postoperative (4 d after TAVR on average) LVEDD was 48.9±6.5 mm, significantly shorter than that preoperatively (50.7±7.3 mm, P < 0.001).There were 53 patients obtaining early improvement of LVEDD before discharge, accounting for 46.9% of the discharged patients.Univariate Cox regression analysis found that preoperative diabetes (HR: 2.635, 95%CI: 1.013~6.858, P=0.047) and postoperative pacemaker implantation (HR: 3.518, 95%CI: 1.336~9.263, P=0.011) were risk factors for MACE at 1 year, and early improvement of LVEDD was a protective factor (HR: 0.176, 95%CI: 0.052~0.601, P=0.006).Multivariate Cox analysis indicated that early LVEDD improvement was still an independent protective factor for MACE at 1 year (HR: 0.231, 95%CI: 0.062~0.857, P=0.029). Conclusion LVEDD can be improved to various degrees in the early stage after TAVR, and the cumulative risk of developing MACE at 1 year in patients with early improvement of LVEDD is lower than that of patients without improvement.

Keywords

• aortic valve stenosis
• transcatheter aortic valve replacement
• early left ventricular end-diastolic diameter
• prognosis