Généreux staging classification in predicting left ventricular reverse remodeling after intervention for severe aortic valve regurgitation

Aims: Severe native aortic regurgitation (AR) is characterized by a progressive left ventricular (LV) dysfunction and remodeling which, up to a certain degree, can be reversed by surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). We aimed to investigate how Généreux staging classification could predict left ventricular reverse remodeling (LVRR). Methods: This monocentric retrospective study analyzes data from 103 patients (29 % female) treated for pure chronic AR in whom echocardiographic examinations had been made before the procedure, in the early postoperative period (48-72 h), and at mid-term follow-up (6 months). The primary endpoint was the occurrence of LVRR defined as a significant reduction in left ventricle end systolic diameter and volume. Results: Compared to patients in Généreux stage 1, we found that patients in Généreux stages ≥2 had a 77 % reduction in the likelihood of LVRR occurrence at early evaluation (OR 0.23; [CI 0.08-0.58; p = 0.002]) and a 74 % reduction in the likelihood of LVRR occurrence at mid-term evaluation (OR 0.26; [CI 0.10-0.60; p = 0.002]). A different course of LVRR was observed in the TAVI group, in which it was slower than SAVR group. Conclusions: Généreux staging classification was found to be an independent prognostic factor for LVRR occurrence. Patients should be treated while being in Genereaux stage 1 since this results in a higher probability of LVRR occurrence.