Association of asymmetric left ventricular remodeling with outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation
A Chwala, J Kwiecinski, A Pylko, M Dabrowski, I Michalowska, R Pracon, Z Chmielak, P Stoklosa, T Hryniewiecki, D Dey, R WolnyAbstract
Background
Aortic stenosis is typically associated with a progressive concentric hypertrophic response of the left ventricular (LV) myocardium. However, an asymmetric pattern of LV remodeling observed in some patients has been associated with earlier LV decompensation, more rapid progression to valve replacement, and an overall impaired prognosis.
Purpose
To evaluate the impact of computed tomography (CT)–derived asymmetric LV remodeling on the acute and long-term outcomes of patients undergoing transcatheter aortic valve implantation (TAVI).
Methods
In this single-center retrospective study, contrast-enhanced ECG-gated CT scans of consecutive patients with severe aortic stenosis undergoing TAVI between 2009 and 2021 were analyzed. Asymmetric LV remodeling was defined as a maximum LV wall thickness-to-opposite wall thickness ratio >1.5, as measured on short-axis diastolic CT images. The primary outcome was all-cause mortality. Secondary outcomes were major in-hospital complications, defined as a composite of major vascular complications, life-threatening or major bleeding, myocardial infarction, stroke, coronary occlusion, annular rupture, pacemaker implantation, or death
Results
A total of 803 patients (median age 82 years, 58% female) were analyzed. The median follow-up was 49 months. Patients with asymmetric LV remodeling (n = 435, 54.2%) were older than those without asymmetric LV remodeling (83 vs. 80 years, p < 0.001), and had greater maximum LV thickness (14.3 vs. 12.5 mm, p<0.01) (Figure 1). The incidence of major complications post TAVI was higher in patients with asymmetric LV remodeling compared with those without asymmetric LV remodeling (38% vs. 29%, p = 0.01). In multivariable logistic regression model asymmetric LV remodeling remained a predictor of major TAVI complications (OR 1.57, 1.1-2.2, p=0.01), independent of age, LV ejection fraction and maximum LV wall thickness. One-year (14% vs. 13%, p = 0.88) and three-year mortality (29% vs. 31%, p = 0.70) did not differ between patients with and without asymmetric LV remodeling (Figure 2).
Conclusions
Asymmetric LV remodeling is a common finding in the elderly population with severe aortic stenosis undergoing TAVI. Our data suggest that it might be associated with an increased risk of in-hospital post-TAVI complications but does not impact long-term prognosis.