Premium
Impact of baseline left ventricular ejection fraction on outcome after transfemoral transcatheter aortic valve implantation in patients with and without low‐gradient aortic stenosis
Author(s) -
ElChilali Karim,
Patsalis Polykarpos Christos,
AlRashid Fadi,
Kahlert Heike Annelie,
Riebisch Matthias,
Mincu RalucaIleana,
Totzeck Matthias,
Lind Alexander,
Jánosi Rolf Alexander,
Kehren Clemens,
Dirkmann Daniel,
Peters Jürgen,
Wendt Daniel,
Jakob Heinz,
Rassaf Tienush,
Kahlert Philipp
Publication year - 2019
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14203
Subject(s) - ejection fraction , medicine , cardiology , stenosis , aortic valve stenosis , heart failure
Objectives To evaluate the impact of baseline left ventricular ejection fraction (LVEF) and its interaction with low‐gradient aortic stenosis (LGAS) on all‐cause mortality after transfemoral aortic valve implantation (TF‐TAVI). Methods We reviewed mortality data of 624 consecutive single center TF‐TAVI patients and categorized LVEF according to current ASE/EACVI recommendations (normal, mildly‐, moderately‐, and severely abnormal). Results Baseline LVEF was normal in 336 (53.8%), mildly abnormal in 160 (25.6%), moderately abnormal in 91 (14.6%), and severely abnormal in 37 (5.9%) patients, and 1‐year mortality was 19%, 17%, 23%, and 43% ( P = 0.002), respectively. Patients with LGAS had a similar 1‐year mortality compared to those without LGAS in groups with normal (19% vs 19%, P = 0.899) and mildly abnormal LVEF (16% vs 17%, P = 0.898). One‐year mortality of patients with LGAS was significantly greater than in those without LGAS in presence of moderately abnormal LVEF (31% vs 11%, P = 0.022), and it was numerically greater than in those without LGAS in presence of severely abnormal LVEF (48% vs 25%, P = 0.219). In multivariate analysis, only the combination of moderately/severely abnormal LVEF and LGAS predicted increased 1‐year mortality (HR: 2.12, 95% CI: 1.4–3.2, P < 0.001). Other variables, including EuroSCORE I did not affect this result. Conclusions Moderately/severely abnormal LVEF (≤40%) at baseline is associated with increased mortality after TF‐TAVI, especially when the mean transvalvular aortic gradient is <40 mm Hg (LGAS), while outcomes in patients with normal and mildly abnormal LVEF are comparable regardless of the pressure gradient across the native aortic valve. (DRKS00013729).