Serial Changes in Left Ventricular Ejection Fraction After Transcatheter Aortic Valve Implantation: Associations With Ischemic Heart Disease and Left Ventricular End-Diastolic Diameter.

PURPOSE: Left ventricular ejection fraction (LVEF) recovery after transcatheter aortic valve implantation (TAVI) varies among patients with severe aortic stenosis and reduced LVEF. We characterized serial changes in LVEF and examined their associations with ischemic heart disease (IHD) and baseline left ventricular end-diastolic diameter. METHODS: Among 685 patients who underwent TAVI between 2014 and 2024, 121 with native-valve severe aortic stenosis and baseline LVEF < 50% were analyzed. Echocardiography was performed before TAVI, early after TAVI (median, 3 days), and at 1, 6, and 12 months. Serial LVEF recovery was evaluated using linear mixed-effects models incorporating all available post-TAVI measurements. RESULTS: LVEF improved significantly through 1 year, with a model-estimated increase of 12.3 percentage points (p < 0.001); left ventricular end-diastolic diameter, end-systolic diameter, and mass index also decreased. In multivariable mixed-effects models, IHD, baseline LVEF, baseline left ventricular end-diastolic diameter, and baseline mean aortic valve pressure gradient were associated with serial LVEF recovery. Adjusted recovery was greatest in patients without IHD and with smaller left ventricular end-diastolic diameter and most limited in those with IHD and larger left ventricular end-diastolic diameter. CONCLUSION: TAVI was associated with serial LVEF improvement and left ventricular reverse remodeling. IHD and larger baseline left ventricular end-diastolic diameter were associated with limited LVEF recovery.