Serial Changes in Left Ventricular Ejection Fraction After Transcatheter Aortic Valve Implantation: Associations With Ischemic Heart Disease and Left Ventricular End-Diastolic Diameter.
TAVI was associated with serial LVEF improvement and left ventricular reverse remodeling, with IHD and larger baseline left ventricular end-diastolic diameter associated with limited LVEF recovery.
Key Findings
Results
LVEF improved significantly through 1 year after TAVI, with a model-estimated increase of 12.3 percentage points.
121 patients with native-valve severe aortic stenosis and baseline LVEF < 50% were analyzed from a cohort of 685 who underwent TAVI between 2014 and 2024
The model-estimated increase of 12.3 percentage points was statistically significant (p < 0.001)
Serial LVEF recovery was evaluated using linear mixed-effects models incorporating all available post-TAVI measurements
Echocardiography was performed before TAVI, early after TAVI (median 3 days), and at 1, 6, and 12 months
Results
Left ventricular end-diastolic diameter, end-systolic diameter, and mass index all decreased following TAVI, indicating left ventricular reverse remodeling.
Reductions were observed across the serial echocardiographic assessments conducted at baseline, early post-TAVI, and at 1, 6, and 12 months
These structural changes occurred alongside the functional improvement in LVEF
The findings are consistent with left ventricular reverse remodeling as a consequence of TAVI
Results
Ischemic heart disease (IHD) was independently associated with limited serial LVEF recovery after TAVI in multivariable analysis.
IHD was identified as a significant predictor of LVEF recovery in multivariable mixed-effects models
Adjusted LVEF recovery was greatest in patients without IHD and most limited in those with IHD
The association persisted after accounting for baseline LVEF, baseline left ventricular end-diastolic diameter, and baseline mean aortic valve pressure gradient
Results
Larger baseline left ventricular end-diastolic diameter was independently associated with limited LVEF recovery after TAVI.
Baseline left ventricular end-diastolic diameter was included as a significant predictor in multivariable mixed-effects models
Patients with smaller left ventricular end-diastolic diameter showed the greatest adjusted LVEF recovery
Patients with both IHD and larger left ventricular end-diastolic diameter showed the most limited LVEF recovery
Patients without IHD and with smaller left ventricular end-diastolic diameter showed the greatest LVEF recovery
Results
Baseline LVEF and baseline mean aortic valve pressure gradient were also associated with serial LVEF recovery in multivariable analysis.
Four variables were identified as significant predictors in the multivariable mixed-effects models: IHD, baseline LVEF, baseline left ventricular end-diastolic diameter, and baseline mean aortic valve pressure gradient
These associations were identified among 121 patients with baseline LVEF < 50% who underwent TAVI
Serial measurements at multiple time points (early post-TAVI, 1, 6, and 12 months) were incorporated into the models
What This Means
This research suggests that patients with severe aortic stenosis and reduced heart pumping function (low ejection fraction) who undergo transcatheter aortic valve implantation (TAVI) — a minimally invasive procedure to replace a diseased heart valve — tend to experience meaningful improvements in heart function over the following year. Among 121 such patients tracked with echocardiography (heart ultrasound) before and up to 12 months after the procedure, the heart's pumping ability increased by an estimated 12 percentage points on average, and the heart muscle itself became smaller and less enlarged, signs of beneficial structural recovery.
However, this research suggests that not all patients recover equally. Two factors were strongly linked to less recovery: having ischemic heart disease (coronary artery disease, where the heart's own blood vessels are narrowed or blocked) and having a more severely enlarged left ventricle before the procedure. Patients with both of these characteristics showed the least improvement in heart function, while those without coronary artery disease and with a less enlarged heart showed the greatest gains.
These findings matter because they could help doctors better predict which patients are likely to benefit most from TAVI in terms of heart function recovery, and which patients may need additional treatments — such as management of coronary artery disease — to optimize their outcomes. The study highlights that while TAVI can improve heart function broadly, the degree of improvement depends significantly on underlying heart conditions that exist before the valve is replaced.
Tanaka K, Kageyama S, Sugiyama H, Sano R, Suzuki T, Endo A, et al.. (2026). Serial Changes in Left Ventricular Ejection Fraction After Transcatheter Aortic Valve Implantation: Associations With Ischemic Heart Disease and Left Ventricular End-Diastolic Diameter.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70626