Impact of coronary artery disease on left ventricular ejection fraction recovery following transcatheter aortic valve implantation. Issue 3 (28th August 2014)

• Record Type: Journal Article
• Authors: Freixa, Xavier; Chan, Jason; Bonan, Raoul; Ibrahim, Ragui; Lamarche, Yoan; Demers, Philippe; Basmadjian, Arsène; Ibrahim, Réda; Cartier, Raymond; Asgar, Anita W.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 85:Issue 3(2015:Feb. 15)
• Page Start: 450
• Page End: 458
• Publication Date: 2014-08-28
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25632
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd25632-sec-0001" sec-type="section"> <title>Objectives</title> <p>The objective of the present study was to assess if the presence and severity of CAD is associated with decreased LVEF recovery after TAVI.</p> </sec> <sec id="ccd25632-sec-0002" sec-type="section"> <title>Background</title> <p>Coronary artery disease (CAD) and low left ventricular ejection fraction (LVEF) are common findings in patients undergoing transcatheter aortic valve implantation (TAVI). The impact of CAD on LVEF recovery after TAVI has not been specifically evaluated.</p> </sec> <sec id="ccd25632-sec-0003" sec-type="section"> <title>Methods</title> <p>All patients with LVEF≤50% who underwent TAVI between March 2006 and May 2012 were included in the study. The presence and severity of coronary artery disease was measured using the Duke Myocardial Jeopardy Score (DMJS). A DMJS = 0 corresponds to patients without CAD or complete revascularization and a DMJS > 0 to those with incomplete revascularization. LVEF recovery was assessed by transthoracic echocardiography, measuring the change in LVEF from baseline to 3‐months post‐TAVI. Myocardial viability was evaluated in a subgroup of patients using cardiac magnetic resonance (CMR) imaging pre‐TAVI.</p> </sec> <sec id="ccd25632-sec-0004" sec-type="section"> <title>Results</title> <p>Fifty‐six patients were included in the study. Twenty‐eight patients (50%) had a DMJS > 0. At 3 months, patients with incomplete revascularization (DMJS > 0) demonstrated less LVEF recovery post‐TAVI (2.0 ± 9.2% versus 11.7 ± 8.9% if DMJS = 0; <italic>P</italic> = 0.001). On multivariate analysis, DMJS and presence of significant delayed‐enhancement were found to be independent predictors of LVEF recovery. Patients with incomplete revascularization exhibited a worse prognosis with higher mortality at 30‐days (22.2% versus 0% if DMJS = 0; <italic>P</italic> = 0.010) and 1‐year (25.9% versus 3.5% if DMJS = 0; <italic>P</italic> = 0.019).</p> </sec> <sec id="ccd25632-sec-0005" sec-type="section"> <title>Conclusions</title> <p>The present study demonstrates an independent association between incomplete revascularization and decreased LVEF recovery in patients with left ventricular dysfunction undergoing TAVI for severe aortic stenosis. © 2014 Wiley Periodicals, Inc.</p> </sec> </abstract>