Impact of an improvement in the early left ventricular ejection fraction on the 1-year clinical outcomes and its predictors after transcatheter aortic valve replacement.

Abstract

Purpose: We evaluated the 1-year clinical outcomes (all-cause mortality, heart failure rehospitalization, and their composite) in patients with severe aortic stenosis (AS) and a preoperative left ventricular ejection fraction (LVEF) < 50% who underwent transcatheter aortic valve replacement (TAVR), and examined the baseline factors predicting ≥ 10% early LVEF improvement.

Methods: We retrospectively analyzed 44 patients who underwent TAVR and divided them into Group R (≥ 10% LVEF improvement, n = 25) or Group N (< 10% improvement, n = 19). A Kaplan-Meier analysis was used to assess the survival rates, and multivariable logistic regression was applied to identify the predictors of LVEF improvement.

Results: The mean patient age was 84.8 ± 4.8 years, and 40.9% were male. Post-TAVR, 56.8% of patients showed ≥ 10% LVEF improvement (mean increase: 16.7 ± 6.1%). The one-year mortality was similar between the groups (p = 0.383), whereas the composite endpoint tended to be higher in Group N (0.4% vs. 21.1%, p = 0.072). The peak aortic valve velocity was the only significant predictor (OR = 0.255, p = 0.048; cutoff: 4.45 m/s, sensitivity, 0.840; specificity, 0.684).

Conclusion: In patients with severe AS and a preoperative LVEF of < 50%, 56.8% demonstrated a significant early LVEF improvement post-TAVR. Patients with a ≥ 10% improvement had a significantly lower 1-year mortality rate.