Prognostic impact of left ventricular ejection fraction recovery in patients undergoing pecutaneous aortic valve replacement. (3rd October 2022)

• Record Type: Journal Article
• Authors: Lopez Otero, D; Bastos Fernandez, M; Sanmartin Pena, X C; Gonzalez Salvado, V; Agra, R; Cid Alvarez, B; Trillo Nouche, R; Iglesias Alvarez, D; Pena Gil, C; Gonzalez Juantey, J R
• Is Part Of: European heart journal. Volume 43(2022)Supplement 2
• Publication Date: 2022-10-03
• Subjects: Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac544.2093
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: A lot of studies have shown a positive effect of transcatheter aortic valve implantation (TAVI) on left ventricular ejection fraction (LVEF). However, the association between long-term outcomes and LVEF recovery after TAVI has not yet been well investigated. Purpose: To detect differences in long-term all cause mortality between patients who recover LVEF at six mounths after TAVI and those who do not. Methods: This is a retrospective, single-center study of 1092 patients undergoing TAVI. LVEF was determined before the intervention and at 6 months. The primary outcome was long-term all-cause mortality. Left ventricular dysfunction was defined as LVEF <50% and recovered LVEF as LVEF >50%. Results: Of the 1.092 patients included, 250 (22.8%) had LVD. Of these, adequate follow-up was only achieved in 188, which were the ones included in the analysis. At 6 months, 86 patients (45.7%) had RLVEF. Table 1 shows the baseline characteristics of patients with RLVEF versus those who did not. No significant differences were found between the two groups in terms of comorbidity, procedural complications, or discharge therapy. There were no differences in baseline LVEF or severity of aortic valve disease, although the transaortic peak gradient (63.9±15.6 vs 73.6±19.7; p=0.019) and transaortic mean peak gradient (38.7±11.2 vs 45±12.7; P=0.026) were significantly higher in the RLVEF group. On the other hand, the group where the LVEF did not recover presented a higher percentage of moderate-severe mitral regurgitation (MR) (25.4 vs 8.1; p=0.005). These data could explain a more advanced state of cardiomyopathy and be an explanation for the different evolution of LVEF. In the multivariate analysis, only moderate-severe MR was associated as a predictor of non-recovery of LVEF after TAVI (HR 1.12; (1.09–1.45); p=0.023). During follow-up RLVEF was associated with a reduction in long-term all-cause mortality (p<0.001) (Figure 1) Conclusions: Up to 25% of patients undergoing TAVI have baseline LVD. Of these, almost half recover it within six months. Patients who recover LVEF have a significant reduction in mortality in the medium term. The presence of a moderate-severe MR was associated with the non-recovery of LVEF after TAVI, probably because it was a more advanced cardiomyopathy. Funding Acknowledgement: Type of funding sources: None.