Introduction: Severe renal dysfunction (SRD) has been shown to have increased diffuse interstitial myocardial fibrosis (DIF). It is unclear how SRD and DIF impact left ventricular remodeling following transcatheter aortic valve replacement (TAVR).
Hypothesis: SRD and DIF negatively impact left ventricular remodeling post TAVR
Methods: Patients with SRD who were referred for echocardiography and CMR for evaluation of potential TAVR between June 2013-June 2016 were evaluated. LV mass, ejection fraction, volumes and native T1mapping for the assessment of DIF were measured at the time of the patients’ baseline CMR. Left ventricular volumes were also measured by echocardiography at baseline and during 1 year follow-up. Findings were compared to a control group matched for age, gender, and presence of comorbidities, who also underwent TAVR between June 2013-June 2016. A mixed effect model was used to assess the impact of TAVR and DIF on changes in LV volumes over time.
Results: We evaluated 191 patients (98 control patients, 93 patients with SRI). See Table 1 for the clinical and imaging findings. There were no significant differences in LV ejection fraction (EF), and LV mass between control and SRD patients at baseline. Mean native T1mapping in patients with ESRD was 1057 ± 55, There was no difference in severity of aortic regurgitation following TAVR between the two groups. Patients with normal renal function experienced a decrease in LVESVi during followup. However, post TAVR LVESVi was significantly different over time in SRD patients compared to controls (p=0.003), with no significant improvement in LVESVi over time. SRD patients with significantly increased DIF demonstrated an increase in LVESVi over time. See Figure.
Conclusion: SRD appears to attenuate positive LV remodeling following TAVR. Patients with increased DIF appear to experience continued adverse LV remodeling, despite TAVR therapy.