[Impact of reduced left ventricular ejection fraction on all-cause mortality of 75 years old and over patients with moderate to severe aortic stenosis].

Objective: To evaluate the impact of left ventricular systolic dysfunction on all-cause mortality of 75 years old and over patients with moderate to severe aortic stenosis. Methods: Clinical data of 301 consecutive aged (≥75 years old) patients with a diagnosis of non-rheumatic moderate to severe aortic stenosis by echocardiography between January 1, 2008 and January 1, 2015 in our hospital were retrospectively analyzed. According to the LVEF, patients were divided into normal LVEF subjects and low LVEF subjects, and the low LVEF level was set at below 60%(≤60%(n=171)vs. >60%(n=130)), 55%(≤55%(n=101)vs. >55%(n=200)), 50%(≤50%(n=65)vs. >50%(n=236)), 45%(≤45%(n=51)vs. >45%(n=250)) and 40%(≤40%(n=37)vs. >40%(n=264)), respectively. All patients were followed to January 1, 2016.The primary end point was death from any cause. Log-rank test was used to compare the mortality between groups. Multivariate Cox regression model analysis was used to identify risk factors related to all-cause death. Results: The patients were followed-up 19 (8 to 37) months. The mortality was similar among the ≤60% and >60% groups(HR=0.741, 95%CI 0.457-1.201, P>0.05), but significantly difference was evidenced between the ≤55% and >55%(HR=0.524, 95%CI 0.329-0.836, P<0.01), ≤50% and >50%(HR=0.371, 95%CI 0.230-0.600, P<0.01), ≤45% and >45%(HR=0.343, 95%CI 0.208-0.564, P<0.01), ≤40% and >40% groups(HR=0.321, 95%CI 0.188-0.548, P<0.01). Among patients receiving conservative therapy, mortality was similar between ≤60% and >60% groups, but mortality was significantly lower in >55% group than in ≤55% group, in >50% group than in ≤50% group, in >45% group than in ≤45% group as well as in >40% group than in ≤40% group (all P<0.01). All-cause mortality was similar in patients treated with TAVR and/or SAVR. After adjusting for age, gender, chronic obstruct pulmonary disease, cerebrovascular disease, and aortic valve transaortic pressure gradient, multivariate Cox regression model analysis showed that patients in LVEF>55% group were associated with lower risk of all-cause mortality compared with≤55% group(HR=0.568, 95%CI 0.340-0.947, P<0.05). Conclusions: Among the 75 years old and over patients with moderate to severe aortic stenosis, LVEF≤55% is related to increased all-cause mortality and In TAVR and/or SAVR group, LVEF is not associated with all-cause mortality.