Influence of early left ventricular end-diastolic diameter improvement on prognosis of severe aortic valve stenosis patients after transcatheter aortic valve replacement

To investigate the early changes of left ventricular end-diastolic diameter（LVEDD）in patients with severe aortic valve stenosis（AS）after transcatheter aortic valve replacement（TAVR）and the effect of the changes on the prognosis of TAVR.

A single-center retrospective cohort study was performed on 113 severe AS patients undergoing TAVR treatment in our hospital from December 2017 to December 2021. When the improvement of postoperative to preoperative LVEDD≥1.8 mm was defined as early LVEDD improvement by echocardiography, the patients were divided into improvement group and non-improvement group. After the patients were followed up in 1 year after TAVR through clinic or telephone visits, their clinical data on cardiac ultrasound, electrocardiogram, and surgery-related complications were collected. The endpoints were major adverse cardiovascular events（MACE）, including 1-year all-cause mortality, myocardial infarction or angina, and heart failure-related hospitalization.

The average age of the patients was 71.2±6.5 years, and 59（52.2%）of them were female. The postoperative（4 d after TAVR on average）LVEDD was 48.9±6.5 mm, significantly shorter than that preoperatively（50.7±7.3 mm, P<0.001）. There were 53 patients obtaining early improvement of LVEDD before discharge, accounting for 46.9% of the discharged patients. Univariate Cox regression analysis found that preoperative diabetes（HR: 2.635, 95%CI: 1.013~6.858, P=0.047）and postoperative pacemaker implantation（HR: 3.518, 95%CI: 1.336~9.263, P=0.011）were risk factors for MACE at 1 year, and early improvement of LVEDD was a protective factor（HR: 0.176, 95%CI: 0.052~0.601, P=0.006）. Multivariate Cox analysis indicated that early LVEDD improvement was still an independent protective factor for MACE at 1 year（HR: 0.231, 95%CI: 0.062~0.857, P=0.029）.

LVEDD can be improved to various degrees in the early stage after TAVR, and the cumulative risk of developing MACE at 1 year in patients with early improvement of LVEDD is lower than that of patients without improvement.