Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation.
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Witberg Guy, Levi Amos, Talmor-Barkan Yeela, Barbanti Marco, Valvo Roberto, Costa Giuliano, Frittitta Valentina, de Backer Ole, Willemen Yannick, van den Dorpel Mark, Mon Matias, Sugiura Atsushi, Sudo Mitsumasa, Masiero Giulia, Pancaldi Edoardo, Arzamendi Dabit, Santos-Martinez Sandra, Baz Jose A, Steblovnik Klemen, Mauri Victor, Adam Matti, Wienemann Hendrik, Zahler David, Hein Manuel, Ruile Philipp, Aodha Brídóg Nic, Grasso Carmelo, Branca Luca, Estévez-Loureiro Rodrigo, Amat-Santos Ignacio J, Mylotte Darren, Bunc Matjaz, Tarantini Giuseppe, Nombela-Franco Luis, Sondergaard Lars, Van Mieghem Nicolas M, Finkelstein Ariel, Kornowski Ran
Аннотация
AIMS: We aimed to assess the likelihood of LV recovery following TAVI, examine its association with midterm mortality, and identify independent predictors of LV function.
METHODS: In our multicentre registry of 17 TAVI centres in Western Europe and Israel, patients were stratified by baseline LV function (ejection fraction [EF] >/≤30%) and LV response: no LV recovery, LV recovery (EF increase ≥10%), and LV normalisation (EF ≥50% post-TAVI).
RESULTS: Our analysis included 10,872 patients; baseline EF was ≤30% in 914 (8.4%) patients and >30% in 9,958 (91.6%) patients. The LV recovered in 544 (59.5%) patients, including 244 (26.7%) patients whose LV function normalised completely (EF >50%). Three-year mortality for patients without severe LV dysfunction at baseline was 29.4%. Compared to this, no LV recovery was associated with a significant increase in mortality (adjusted hazard ratio 1.32; p<0.001). Patients with similar LV function post-TAVI had similar rates of 3-year mortality, regardless of their baseline LV function. Three variables were associated with a higher likelihood of LV recovery following TAVI: no previous myocardial infarction (MI), estimated glomerular filtration rate >60 mL/min, and mean aortic valve gradient (mAVG) (expressed either as a continuous variable or as a binary variable using the standard low-flow, low-gradient aortic stenosis [AS] definition).
CONCLUSIONS: LV recovery following TAVI and the extent of this recovery are major determinants of midterm mortality in patients with severe AS and severe LV dysfunction undergoing TAVI. Patients with no previous MI and those with an mAVG >40 mmHg show the best results following TAVI, which are at least equivalent to those for patients without severe LV dysfunction. (ClinicalTrials.gov: NCT04031274).