Preprocedural left ventricular hypertrophy (LVH), based on LV mass index and relative wall thickness, was not associated with adverse outcomes at one-year in patients who underwent transcatheter aortic valve replacement (TAVR), according to a study using NCDR data published in JACC: Cardiovascular Interventions.

Using the STS/ACC TVT Registry, Anubodh S. Varshney, MD, et al., identified 31,199 TAVR patients at 422 sites who underwent TAVR from November 2011 through June 2016. Patients were evaluated by varying LVH patterns, using sex-specific cutoffs for LV mass index and relative wall thickness. Researchers evaluated the association between LVH pattern (concentric remodeling, concentric LVH, eccentric LVH) and outcomes (rates of mortality, myocardial infarction, stroke, new dialysis requirement) at one-year using multivariate hazard models.

The investigators found no significant associations between concentric remodeling, concentric LVH or eccentric LVH and outcomes at one year, compared with patients without LVH.

Overall, the analysis of a large cohort of real-world patients showed that about 60 percent had some degree of LVH, and most had a concentric pattern and the pattern and severity varied by sex. Further, there were no clinically significant associations between the different LVH patterns or severity and clinical outcomes during the index hospitalization or at one-year.

The authors write that TAVR is likely to benefit patients with severe aortic stenosis regardless of the presence of LVH. They recommend further research to compare outcomes between patients with LVH who undergo TAVR accounting for LV diastolic regression, intracavitary flow gradient, LVMI regression and myocardial fibrosis, and to determine the longer term impact of preprocedural LVH on TAVR outcomes.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: Hypertrophy, Left Ventricular, Transcatheter Aortic Valve Replacement, Proportional Hazards Models, Renal Dialysis, Aortic Valve Stenosis, Myocardial Infarction, Registries, National Cardiovascular Data Registries, Stroke, Hospitalization, Cohort Studies, STS/ACC TVT Registry

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