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Early regression of severe left ventricular (LV) hypertrophy is associated with reduced risk of subsequent hospitalization in patients undergoing transcatheter aortic valve replacement (TAVR), according to a study published in the June 2014 issue of JACC: Cardiovascular Interventions.

Compared with those with lesser LV mass regression at 30 days, those with greater regression had a higher baseline measurement but lower subsequent measurements at 30 days, 6 months, and 1 year (P < .05 for each comparison). Those with greater LV mass regression at 30 days experienced no change during the remainder of the year (P = .22), whereas those with lesser LV mass regression at 30 days had regression during the remainder of the year (P < .001). 

Overall, patients’ LV mass index decreased from 166 ± 31 g/m² at baseline to 137 ± 35 g/m² at 1 year (P < .001). More than half of that regression occurred within the first 30 days.

At 1 year, there was no difference between patients with greater and lesser than median LV mass regression with regard to mortality or stroke, but rehospitalizations were reduced for those with greater regression (table 1).

Table 1. Outcomes by LV Mass Index Regression: 30-365 Days Post-TAVR

The improvement in repeat hospitalization rate with greater regression was consistent across a number of prespecified subgroups and was maintained after multivariate analysis. An LV mass index regression of 10% was the optimal cutoff for predicting repeat hospitalizations.

Mechanisms, Clinical Implications  

The potential mechanism underlying the decrease in rehospitalization could be related to B-type natriuretic peptide levels, according to the authors. Patients with greater LV mass regression had lower levels of the peptide at both 180 and at 365 days, they report, and this is consistent with improved LV function and less heart failure, which was the primary reason for repeat hospitalizations. 

Earlier attempts to show associations between LV hypertrophy regression after TAVR and outcome were inconclusive, Dr. Lindman and colleagues explain, thus the results are a welcome confirmation of the assumption.

Dr. Lindman pointed out to TCTMD in an email that some of the variables associated with early LV mass index regression cannot be changed including pacemaker use and gender. “Our findings provide a rationale for further studies to identify modifiable risk factors that may contribute to regression of LV mass after valve replacement for aortic stenosis,” he said. “[This] may help identify adjunctive medical therapy that could accentuate LV mass regression and improve clinical outcomes.” 

Also, studies that look in detail at the severity of LV hypertrophy could help influence clinical decision making, Dr. Lindman observed.

Note: Coauthor Martin B. Leon, MD, is a faculty member of the Cardiovascular Research Foundation, which owns and operates TCTMD.

 Source: 
Lindman BR, Stewart WJ, Pibarot P, et al. Early regression of severe left ventricular hypertrophy after transcatheter aortic valve replacement is associated with decreased hospitalizations. J Am Coll Cardiol Intv. 2014;7:662-673.

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