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Background <p>Mixed aortic valve disease (MAVD), characterized by concurrent presence of aortic stenosis (AS) and aortic regurgitation (AR), exhibits distinct cardiac structural and functional characteristics compared to isolated aortic valve disease. The aim of the present study was to elucidate the impact of cardiac reverse remodeling after transcatheter aortic valve replacement (TAVR) on prognosis in MAVD.</p> Methods <p>The present study included patients with severe symptomatic AS and moderate or greater AR who underwent TAVR and both preoperative and one-year follow-up echocardiography. Reverse remodeling after TAVR was defined as the change of each left ventricular end-systolic volume index (LVESVi), end-diastolic volume index or mass index from baseline to one-year follow-up. The primary outcome was a composite of cardiac death and hospitalization due to heart failure. Internal validation was performed bootstrap resampling methods.</p> Results <p>A total of 143 patients was enrolled (83.4 ± 6.0 years, 46.9% male). During a median follow-up period of 519 days, 17 patients achieved the primary outcome. Decrease of LVESVi with a cut-off value of 36% was optimal at identifying favorable prognosis (area under the curve: 0.65, sensitivity: 35%, specificity:100%, <i>P</i> = 0.045). Patients with ≥ 36% reduction of LVESVi after TAVR had significantly better prognosis than those without it (<i>P</i> = 0.004). Preoperative larger LVESVi and higher LV mass index were predictors of ≥ 36% decrease of LVESVi following TAVR.</p> Conclusion <p>Greater decrease of LVESVi following TAVR was associated with improved postoperative prognosis in MAVD. Patients with more advanced preoperative cardiac remodeling exhibited greater postoperative reverse remodeling.</p>

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Association of cardiac reverse remodeling with prognosis after transcatheter aortic valve replacement in patients with mixed aortic valve disease

  • 期刊论文

  • 发表日期：

    2025年11月8日

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  • Akihiro Tani,
  • Yoshihito Saijo,
  • Kenya Kusunose,
  • Tomonori Takahashi,
  • Hirotsugu Yamada,
  • Masataka Sata,
  • Kimi Sato,
  • Noor Albakaa,
  • Tomoko Ishizu,
  • Yoshihiro Seo,
  • Masaki Izumo,
  • Atsushi Okada,
  • Chisato Izumi,
  • Shu Inami,
  • Yasuharu Takeda,
  • Toshinari Onishi,
  • Yuki Izumi,
  • Akiko Kumagai,
  • Tomoko Fukuda,
  • Naohiko Takahashi,
  • Takeshi Kitai,
  • Hiroyuki Iwano,
  • Shigeo Sugawara,
  • Kazumi Akasaka,
  • Kenji Harada,
  • Yoshiko Masaoka,
  • Kazuaki Tanabe,
  • Takahiro Sakamoto,
  • Takeshi Takamura

摘要

Background

Mixed aortic valve disease (MAVD), characterized by concurrent presence of aortic stenosis (AS) and aortic regurgitation (AR), exhibits distinct cardiac structural and functional characteristics compared to isolated aortic valve disease. The aim of the present study was to elucidate the impact of cardiac reverse remodeling after transcatheter aortic valve replacement (TAVR) on prognosis in MAVD.

Methods

The present study included patients with severe symptomatic AS and moderate or greater AR who underwent TAVR and both preoperative and one-year follow-up echocardiography. Reverse remodeling after TAVR was defined as the change of each left ventricular end-systolic volume index (LVESVi), end-diastolic volume index or mass index from baseline to one-year follow-up. The primary outcome was a composite of cardiac death and hospitalization due to heart failure. Internal validation was performed bootstrap resampling methods.

Results

A total of 143 patients was enrolled (83.4 ± 6.0 years, 46.9% male). During a median follow-up period of 519 days, 17 patients achieved the primary outcome. Decrease of LVESVi with a cut-off value of 36% was optimal at identifying favorable prognosis (area under the curve: 0.65, sensitivity: 35%, specificity:100%, P = 0.045). Patients with ≥ 36% reduction of LVESVi after TAVR had significantly better prognosis than those without it (P = 0.004). Preoperative larger LVESVi and higher LV mass index were predictors of ≥ 36% decrease of LVESVi following TAVR.

Conclusion

Greater decrease of LVESVi following TAVR was associated with improved postoperative prognosis in MAVD. Patients with more advanced preoperative cardiac remodeling exhibited greater postoperative reverse remodeling.