Reverse left ventricular remodeling after aortic valve replacement for aortic stenosis: systematic review and meta-analysis

Abstract

Introduction and Objectives: Reverse Left Ventricle (LV) remodeling after Aortic Valve Replacement (AVR), in patients with aortic stenosis, is well documented as an important prognostic factor. However, there are no reference values for the expected reverse remodeling phenomenon. With this systematic review and meta-analysis, we aimed to characterize the response of the unloaded LV after AVR. Methods: We searched on MEDLINE/PubMed, Web of Science, and Embase for studies reporting echocardiographic findings before and at least 1 month after AVR for the treatment of aortic stenosis. 5626 studies were identified and 4493 were screened for inclusion. Main factors of interest were structural and dynamic measures of the LV and Aortic Valve. We performed a random-effects meta-analysis to compute standardized mean differences (SMD) between follow-up and baseline values for each outcome. Results: 31 studies met the eligibility criteria, yielding 2206 patients. AVR resulted in reduced Mean Aortic Gradient (SMD: -42.18, 95% CI: -44.39 to -39.96, I2 = 95.8%), LV Mass (for surgical AVR, SMD: -84.40, CI: -103.24 to -65.57, I2 = 78.4%), Indexed LV Mass (SMD: -40.31, CI: -47.39 to -33.22, I2 = 78.8%), End-Diastolic LV Diameter (SMD: -2.06, CI: -3.17 to -0.94, I2 = 87.3%), End-Diastolic LV Volume (SMD: -13.10, CI: -18.77 to -7.43, I2 = 52.4%), Posterior Wall Thickness (SMD: -1.89, CI: -2.50 to -1.29, I2 = 94.1%), Interventricular Septal Thickness (SMD: -1.72, CI: -2.12 to -1.33, I2 = 88.1%), and increased Effective Aortic Valve Area (SMD: 1.02, CI: 0.86 to 1.18, I2 = 96.9%), and LV Ejection Fraction (SMD: 3.54, CI 2.22 to 4.86, I2 = 90.6%). Conclusions: Reverse remodeling occurs after AVR and it is expressed in all of the main factors of interest of this systematic review and meta-analysis.