Transcatheter aortic valve implantation improves left ventricular function and hemodynamics and reduces severe ventricular arrhythmias in patients with severe aortic stenosis

Abstract

Objective

To assess changes in LV function, hemodynamics, and ventricular arrhythmias (VAs) after transcatheter aortic valve implantation (TAVI) in severe aortic stenosis (AS) patients at 1-month and 1-year follow-up.

Methods

Eighty severe AS patients undergoing TAVI were analyzed after exclusions (prior pacemaker, post-TAVI complications, death, or missing data). Echocardiography (left ventricular ejection fraction [LVEF], left ventricular end-diastolic diameter [LVEDD], mean transaortic gradient), NT-proBNP levels, and 24-h Holter monitoring (modified Lown grading for VAs) were evaluated pre-TAVI, at 1 month, and 1 year post-TAVI.

Results

At 1 month, LVEF improved from 41.5 ± 7.8% to 48.0 ± 6.0% (P = 0.034), LVEDD decreased from 56.6 ± 11.5 mm to 54.0 ± 11.0 mm (P = 0.020), and mean gradient dropped from 54.8 ± 9.5 mmHg to 18.2 ± 4.5 mmHg (P < 0.001). NT-proBNP decreased from 3870 pg/mL (IQR: 780–26500) to 1015 pg/mL (IQR: 550–8500) (P < 0.01). Lown grade 3–4 VAs declined from 33.8% to 17.5% (P = 0.030). At 1 year, LVEF further improved to 51.5 ± 5.5% (P < 0.001), LVEDD to 52.5 ± 10.8 mm (P < 0.01), and mean gradient to 15.5 ± 4.0 mmHg (P < 0.001). NT-proBNP remained low (850 pg/mL, IQR: 450–15500; P < 0.001), and Lown 3–4 VAs decreased to 12.5% (P < 0.001). Ventricular tachycardia incidence reduced from 12.5% pre-TAVI to 5.0% at 1 year (P = 0.016).

Conclusion

TAVI significantly improves LV function, promotes reverse remodeling, and reduces severe VAs in severe AS patients, with sustained benefits at 1 year, highlighting its positive impact on cardiac structure, function, and arrhythmic burden.