Transcatheter Aortic Valve Replacement and Left Ventricular Geometry: Survival and Gender Differences

Background: The aim of this study was to examine the relationship between baseline left ventricular (LV) geometry and outcomes after transcatheter aortic valve replacement (TAVR). Methods: Patients undergoing TAVR (n = 206) had baseline LV geometry classified as (1) concentric hypertrophy, (2) eccentric hypertrophy, (3) concentric remodeling, or (4) normal. Descriptive statistics, Kaplan-Meier time-to-event analysis, and Cox regression were performed. Results: Distribution of baseline LV geometry differed between male and female patients (χ² = 16.83, P = .001) but not at 1 month (χ² = 2.56, P = .47) or 1 year (χ² = 5.68, P = .13). After TAVR, a majority of patients with concentric hypertrophy evolved to concentric remodeling. Survival differed across LV geometry groups at 1 year (χ²[3] = 8.108, P = .044, log-rank test) and at 6.5 years (χ²[3] = 9.023, P = .029, log-rank test). Compared with patients with concentric hypertrophy, patients with normal geometry (hazard ratio, 2.25; 95% CI, 1.12–4.54; P = .023) and concentric remodeling (hazard ratio, 1.89; 95% CI, 1.12–3.17; P = .016) had higher rates of all-cause mortality. Conclusions: Baseline concentric hypertrophy confers a survival advantage after TAVR. Although baseline patterns of LV geometry appear gender specific (with women demonstrating more concentric hypertrophy), this difference resolves after TAVR.