# Left ventricular systolic recovery after TAVI in severe aortic stenosis: A systematic review and meta-analysis

## TL;DR

This study finds that nearly half of patients with heart issues recover heart function after a specific heart procedure called TAVI.

## Contribution

The study provides a comprehensive meta-analysis of LV systolic recovery after TAVI using a large patient cohort and identifies baseline LVEF as a key predictor.

## Key findings

- LV systolic recovery was observed in 49% of patients with reduced LVEF after TAVI.
- Baseline LVEF is a significant predictor of recovery, with lower values associated with higher recovery likelihood.
- Recovery was consistent across all follow-up periods, from immediately post-procedure to one year.

## Abstract

Severe aortic stenosis (AS) imposes chronic pressure overload on the left ventricle (LV), leading to adverse remodeling and systolic dysfunction. While transcatheter aortic valve implantation (TAVI) can reverse this process, the overall prevalence and predictors of LV functional recovery are not fully understood. This study aims to assess the left ventricular ejection fraction (LVEF) recovery following TAVI.

A meta-analysis was conducted in accordance with PRISMA guidelines. The PubMed, Scopus, Web of Science, and Cochrane databases were searched from inception through November 2024 for studies reporting on LVEF improvement after TAVI in patients with severe AS. The primary outcome was LVEF improvement, defined as an absolute increase of ≥10% from baseline. A random-effects model was employed for all pooled analyses to account for inter-study heterogeneity.

Eighteen studies encompassing 4782 patients met the inclusion criteria. In the subgroup of patients with reduced LVEF, 14 studies with a total of 3182 patients reported a LV systolic recovery of 49% (95% CI: 40-57; I2 = 97%). The recovery was observed across all follow-up periods, from immediately post-procedure to one-year. A meta-regression has identified that baseline LVEF is a predictor of LV systolic recovery (β = −0.042 (95% CI: [-0.075, −0.008], p = 0.018, I2 = 93.31%).

TAVI is associated with substantial LV systolic recovery in nearly half of all patients with pre-existing systolic dysfunction. These findings underscore the prognostic importance of myocardial recovery in this high-risk patient population and can inform clinical decision-making and patient counseling.

Parts of the graphical abstract were drawn using pictures from Servier Medical Art (smart.servier.com), provided by Servier, licensed under a Creative Commons Attribution 4.0 license (CC BY 4.0). (https://creativecommons.org/licenses/by/4.0/).Image 1

•The true rate of LV recovery after TAVI remained unclear due to small sample sizes and inconsistent data in prior studies.•This meta-analysis synthesized data from 4,782 patients across 18 studies to robustly quantify post-TAVI outcomes.•Significant LV recovery was observed in 49% of patients with baseline dysfunction.•A lower baseline ejection fraction emerged as the strongest independent predictor of myocardial recovery.•Clinicians can now counsel high-risk patients regarding a roughly 50% probability of functional improvement post-TAVI.

The true rate of LV recovery after TAVI remained unclear due to small sample sizes and inconsistent data in prior studies.

This meta-analysis synthesized data from 4,782 patients across 18 studies to robustly quantify post-TAVI outcomes.

Significant LV recovery was observed in 49% of patients with baseline dysfunction.

A lower baseline ejection fraction emerged as the strongest independent predictor of myocardial recovery.

Clinicians can now counsel high-risk patients regarding a roughly 50% probability of functional improvement post-TAVI.