Comparison of left ventricular reverse remodeling and prognosis after transcatheter aortic valve replacement in aortic stenosis and mixed aortic valve disease
10.3969/j.issn.1004-8812.2025.02.002
- VernacularTitle:主动脉瓣狭窄与混合性主动脉瓣疾病患者经导管主动脉瓣置换术后左心室逆重构及预后的比较研究
- Author:
Meng SUN
1
;
Lu-lin CHEN
1
;
Jing-yun BAI
1
;
Li-jie YAN
1
;
Jing-jing LIU
1
;
Xian-wei FAN
1
;
Xue-jie LI
1
;
Juan HU
1
;
Jin-tao WU
1
;
Hai-tao YANG
1
Author Information
1. 阜外华中心血管病医院 郑州大学华中阜外医院心内科,河南郑州 451464
- Publication Type:Journal Article
- Keywords:
Left ventricular reverse remodeling;
Mixed aortic valve disease;
Aortic stenosis;
Transcatheter aortic valve replacement
- From:
Chinese Journal of Interventional Cardiology
2025;33(2):71-78
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the effects of transcatheter aortic valve replacement(TAVR)on left ventricular reverse remodeling(LVRR)and outcomes in patients with mixed aortic valve disease(MAVD)and predominant aortic stenosis(AS).Methods Patients undergoing TAVR at our center between January 2020 and December 2022 were enrolled consecutively.Propensity score matching(PSM)(1∶1 ratio)was used to reduce selection bias.Transthoracic echocardiography(TTE)was used to monitor left ventricular ejection fraction(LVEF)and other structural parameters over time.The study outcome was a composite of cardiovascular death and rehospitalization due to cardiovascular causes.Linear mixed-effects models and logistic regression were utilized for comparing echocardiographic changes across groups and identifying independent risk factors for no-LVRR,respectively.Results After PSM,126 patients were included.MAVD group exhibited larger structural parameters(left ventricular end-systolic/end-diastolic diameter and volume,left ventricular mass index)and a lower left ventricular ejection fraction(LVEF)(all P＜0.05).However,more pronounced improvements in left ventricular structure and hemodynamics were observed during follow-up.Multivariate logistic regression analysis indicated that the left ventricular mass index(LVMI)was an independent predictor of left ventricular reverse remodeling(LVRR)after TAVR,whereas persistent moderate or greater mitral regurgitation(MR)and paravalvular leak(PVL)significantly reduced the incidence of LVRR.During a median follow-up period of 23 months,a total of 31 endpoint events occurred,and there was no statistically significant difference in long-term prognosis between the two groups(Log-rank P=0.330).Conclusions Compared to patients in the AS group,those in the MAVD group exhibited more severe left ventricular remodeling before TAVR.However,more significant LVRR was observed during postoperative follow-up.Additionally,the long-term prognosis was comparable between the two groups.
