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Meta-Analysis
. 2020 Jun 1;22(1):41.
doi: 10.1186/s12968-020-00629-9.

Cardiac structural changes after transcatheter aortic valve replacement: systematic review and meta-analysis of cardiovascular magnetic resonance studies

Ghazaleh Mehdipoor  1 , Shmuel Chen  1   2 , Saurav Chatterjee  3 , Pooya Torkian  4 , Ori Ben-Yehuda  1   2 , Martin B Leon  1   2 , Gregg W Stone  1   5 , Martin R Prince  6   7
Affiliations
Meta-Analysis

Cardiac structural changes after transcatheter aortic valve replacement: systematic review and meta-analysis of cardiovascular magnetic resonance studies

Ghazaleh Mehdipoor et al. J Cardiovasc Magn Reson. .

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with severe aortic stenosis (AS). Cardiovascular magnetic resonance imaging (CMR) provides reliable and reproducible estimates for assessment of cardiac structure and function after TAVR. The goal of this study was to conduct a systematic review and meta-analysis of the literature to assess left ventricular (LV) volumes, mass and function by CMR after TAVR.

Methods: Using Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, we searched PubMed and Embase for studies reporting CMR findings before and at least 1 month after TAVR. Main factors of interest were LV end-diastolic volume index (LVEDVi), LV end-systolic volume index (LVESVi), LV mass index (LVMi), and left ventricular ejection fraction (LVEF). Standardized mean differences (SMD) were pooled by random effects meta-analytic techniques.

Results: Of 453 screened publications, 10 studies (published between 2012 and 2018) were included. A total of 305 patients completed pre- and post-TAVR follow-up CMR (mean age range 78.6-85.0 years, follow-up range 6-15 months). Random effects analysis showed TAVR resulted in reduced LVEDVi (SMD: -0.25, 95% CI: - 0.43 to - 0.07, P = 0.006), LVESVi (SMD: -0.24, 95% CI: - 0.44 to - 0.05, P = 0.01), LVMi (SMD: -0.82, 95% CI: - 1.0 to - 0.63, P < 0.001) and increased LVEF (SMD: 22, 95% CI: 6 to 38%, P = 0.006). Heterogeneity across studies was low (I2: 0%, Pheterogeneity > 0.05 for all). The median reduction was 4 ml/m2 (IQR: 3.1 to 8.2) for LVEDVi, 5 ml/m2 (IQR: 3.0 to 6.0) for LVESVi, and 15.1 g/m2 (IQR: 11.8 to 18.3) for LVMi. The median increase for LVEF was 3.4% (IQR 1.0 to 4.6%).

Conclusions: CMR demonstrates reverse LV remodeling occurrs within 6-15 months after TAVR, with reductions in LVEDVi, LVESVi and LVMi, and increased LVEF.

Keywords: Aortic stenosis; Cardiac structure; Magnetic resonance imaging (MRI); Transcatheter aortic valve implantation (TAVI); Transcatheter aortic valve replacement (TAVR).

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Conflict of interest statement

GM, SC, SC, PT, OB have no relevant Disclosures. Dr. Leon reports grants and other from Edwards Lifesciences, during the conduct of the study; grants and personal fees from Medtronic, grants and personal fees from Boston Scientific, personal fees from Gore Medical, personal fees from Meril Lifescience, grants and personal fees from Abbott, outside the submitted work. Dr. Stone is consultant to Gore. Dr. Prince has an unrelated patent agreement with GE Healthcare.

Figures

Fig. 1
Fig. 1
Flow diagram of included studies
Fig. 2
Fig. 2
Left ventricular (LV) changes, standardized mean difference (SMD) post-TAVR vs. pre-TAVR for: a. LVEDVi, b. LVESVi, c. LVMi, d. LVEF. LVEDVi, left ventricular end-diastolic volume index; LVEF, left ventricular ejection fraction; LVESVI, left ventricular end-systolic volume index, LVMi, left ventricular mass index; TAVR, transcatheter aortic valve replacement
Fig. 2
Fig. 2
Left ventricular (LV) changes, standardized mean difference (SMD) post-TAVR vs. pre-TAVR for: a. LVEDVi, b. LVESVi, c. LVMi, d. LVEF. LVEDVi, left ventricular end-diastolic volume index; LVEF, left ventricular ejection fraction; LVESVI, left ventricular end-systolic volume index, LVMi, left ventricular mass index; TAVR, transcatheter aortic valve replacement
Fig. 2
Fig. 2
Left ventricular (LV) changes, standardized mean difference (SMD) post-TAVR vs. pre-TAVR for: a. LVEDVi, b. LVESVi, c. LVMi, d. LVEF. LVEDVi, left ventricular end-diastolic volume index; LVEF, left ventricular ejection fraction; LVESVI, left ventricular end-systolic volume index, LVMi, left ventricular mass index; TAVR, transcatheter aortic valve replacement
Fig. 2
Fig. 2
Left ventricular (LV) changes, standardized mean difference (SMD) post-TAVR vs. pre-TAVR for: a. LVEDVi, b. LVESVi, c. LVMi, d. LVEF. LVEDVi, left ventricular end-diastolic volume index; LVEF, left ventricular ejection fraction; LVESVI, left ventricular end-systolic volume index, LVMi, left ventricular mass index; TAVR, transcatheter aortic valve replacement
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