Cardiac structural changes after transcatheter aortic valve replacement: systematic review and meta-analysis of cardiovascular magnetic resonance studies

Abstract

Background Transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with severe aortic stenosis (AS). Cardiovascular magnetic resonance imaging (CMR) provides reliable and reproducible estimates for assessment of cardiac structure and function after TAVR. The goal of this study was to conduct a systematic review and meta-analysis of the literature to assess left ventricular (LV) volumes, mass and function by CMR after TAVR. Methods Using Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, we searched PubMed and Embase for studies reporting CMR findings before and at least 1 month after TAVR. Main factors of interest were LV end-diastolic volume index (LVEDVi), LV end-systolic volume index (LVESVi), LV mass index (LVMi), and left ventricular ejection fraction (LVEF). Standardized mean differences (SMD) were pooled by random effects meta-analytic techniques. Results Of 453 screened publications, 10 studies (published between 2012 and 2018) were included. A total of 305 patients completed pre- and post-TAVR follow-up CMR (mean age range 78.6–85.0 years, follow-up range 6–15 months). Random effects analysis showed TAVR resulted in reduced LVEDVi (SMD: -0.25, 95% CI: − 0.43 to − 0.07, P = 0.006), LVESVi (SMD: -0.24, 95% CI: − 0.44 to − 0.05, P = 0.01), LVMi (SMD: -0.82, 95% CI: − 1.0 to − 0.63, P < 0.001) and increased LVEF (SMD: 22, 95% CI: 6 to 38%, P = 0.006). Heterogeneity across studies was low (I2: 0%, Pheterogeneity > 0.05 for all). The median reduction was 4 ml/m2 (IQR: 3.1 to 8.2) for LVEDVi, 5 ml/m2 (IQR: 3.0 to 6.0) for LVESVi, and 15.1 g/m2 (IQR: 11.8 to 18.3) for LVMi. The median increase for LVEF was 3.4% (IQR 1.0 to 4.6%). Conclusions CMR demonstrates reverse LV remodeling occurrs within 6–15 months after TAVR, with reductions in LVEDVi, LVESVi and LVMi, and increased LVEF.

Neutrophil-to-lymphocyte ratio as a predictor of inflammatory response in patients with acute kidney injury after transcatheter aortic valve implantation

“…Left ventricular remodelling occurs after TAVI, with reductions in left ventricular end-diastolic volume index, end-systolic volume index, left ventricular mass index, and increased LVEF. 34 Abu Khadija et al showed that the reduction of the NLR as an inflammatory marker after TAVI in group with reduced left ventricular function caught up with the NLR in patients with preserved left ventricular function after 6 months of follow-up. 26 Condado et al showed that elevated NLR and plateletlymphocyte ratio (PLR) are associated with a higher Society of Thoracic Surgeons -Predicted Risk of Mortality (STS-PROM) score.…”

HFA‐PEFF score: prognosis in patients with preserved ejection fraction after transcatheter aortic valve implantation

“…3 TAVI can potentially induce reverse remodelling, which can lead to structural and functional improvements. 5,6 Treating patients earlier in the AS disease course may help limit diastolic dysfunction and potentially reduce the negative impact of HFpEF. Valvular heart disease, such as AS, may mimic HFpEF, making the diagnosis of HFpEF particularly challenging in this context.…”

“…3 Transcatheter aortic valve implantation (TAVI) has been shown to potentially induce a process of reverse remodelling leading to structural and functional improvements. 5,6 A substantial proportion of TAVI patients may have underlying heart failure with preserved ejection fraction (HFpEF) in addition to AS, due to the fact that both entities share common risk factors, such as age, hypertension, diabetes and chronic kidney disease. 7,8 Although mortality and heart failure hospitalization rates of patients with HFpEF are known to be high, the prognostic implications of HFpEF are not adequately reflected by current risk prediction models, such as the Society of Thoracic Surgeons score (STS) and guidelines for the management of patients undergoing TAVI.…”

Functional and structural reverse myocardial remodeling following transcatheter aortic valve replacement: a prospective cardiovascular magnetic resonance study

“…In this context, especially cardiovascular magnetic resonance (CMR) imaging is of growing importance as an appropriate non-invasive tool for comprehensive myocardial analyses including strain and tissue analyses. Previous CMR studies have demonstrated detection of volumetric functional improvement following TAVR and recently applied CMR imaging to identify dynamic structural changes of myocardial compartments assessing reverse myocardial remodeling and recovery from AS [ 10 , 11 ]. Importantly, CMR imaging allows non-invasive assessment of myocardial fibrosis, which is of growing relevance as another parameter for ventricular failure in AS patients and possesses important prognostic informations [ 12 , 13 ].…”