Serial echocardiographic changes in left ventricular size and calculated mass after transcatheter aortic valve replacement for predominant native aortic regurgitation without severe aortic stenosis: a retrospective cohort study

Abstract

Left ventricular end-diastolic diameter (LVEDD) is widely available but is one-dimensional and load dependent. We evaluated serial LV size and calculated LV mass after TAVR for predominant native aortic regurgitation (AR) without severe aortic stenosis (AS), using all quantitative and semi-quantitative information available in routine clinical echocardiographic reports. This retrospective single-center study included 62 patients treated between January 2023 and February 2025. Echocardiographic measurements were extracted from contemporaneous clinical reports; original image loops were unavailable for retrospective core-laboratory remeasurement. AR severity, report-derived regurgitant jet area, valve morphology, aortic-root measurements, procedural characteristics, and residual AR were summarized with variable-specific denominators. Linear mixed-effects models assessed serial LVEDD and calculated LV mass. Approximate 1-year paired analyses included one additional 249-day examination recovered during report re-review. Baseline AR was severe or very severe in 55 patients and moderate-to-severe in 7. Regurgitant jet area was available in 39 patients (median 9.9 (9.3–11.2) cm²). Numeric vena contracta, EROA, and regurgitant volume were not recorded with sufficient consistency for analysis. LVEDD decreased at every postprocedural window in mixed-effects analysis (adjusted approximate 1-year difference, -5.89 mm; 95% CI, -7.67 to -4.11; P < 0.001). Calculated LV mass also decreased (adjusted approximate 1-year difference, -47.8 g; 95% CI, -66.1 to -29.5; P < 0.001). Among 30 patients with approximate 1-year LVEDD, median LVEDD change was − 7.0 (-10.8–2.0) mm ( P < 0.001). Calculated LV mass decreased by -47.4 (-90.6-4.0) g ( P = 0.002), and LV mass index decreased by -30.2 (-58.4-2.4) g/m² ( P = 0.003). Moderate-or-greater residual AR was documented in 5 of 61 patients; early LVEDD change was less favorable in the four patients with paired early data than in those with none/mild residual AR (median + 1.5 vs. -4.0 mm; exploratory P = 0.008). Serial clinical echocardiography showed reductions in LVEDD and calculated LV mass after TAVR in selected patients with predominant native AR without severe AS. These findings are descriptive and hypothesis-generating, and do not establish load-independent or definitive reverse remodeling because imaging was not remeasured by a core laboratory, follow-up was incomplete, and numeric vena contracta, EROA, regurgitant volume, and volumetric LV measurements were not routinely available.