Impact of flow on outcomes in patients with left ventricular systolic dysfunction undergoing TAVR.

IF 1.9 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine Pub Date : 2025-09-13 DOI:10.1016/j.carrev.2025.09.005

Besir Besir, Shivabalan Kathavarayan Ramu, Maryam Muhammad Ali Majeed-Saidan, Judah Rajendran, James J Y Yun, Rishi Puri, Grant W Reed, Amar Krishnaswamy, Rhonda Miyasaka, Serge C Harb, Samir R Kapadia

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引用次数: 0

Abstract

Background: TAVR is associated with better outcomes for patients with classical low-flow low-gradient aortic stenosis (C-LFLG AS) and normal-flow low-gradient (NFLG AS) compared to medical management. Left ventricular ejection fraction (LVEF) predicts mortality in patients undergoing TAVR. However, the outcomes based on flow in patients with lower LVEF undergoing TAVR remain unclear.

Objectives: This study explored the outcomes of patients with reduced LVEF undergoing TAVR with C-LFLG AS and NFLG AS. It also explored the hemodynamic changes post-TAVR in these populations and identified factors determining their outcomes.

Methods: In this retrospective, single-center study involving 305 patients with severe AS, patients were classified into 2 groups: 1) C-LFLG AS, AV mean gradient (MG) <40 mmHg, stroke volume index (SVI) <35 mL/m², LVEF <50 %; 2) Low LVEF NFLG AS: MG <40 mmHg, SVI ≥35 mL/m², LVEF <50 %. Binary logistic regression was used to assess the determinants of C-LFLG AS and NFLG AS. Cox regression was used to determine the clinical outcomes.

Results: Of 2600 patients undergoing TAVR, low LVEF patients meeting the inclusion criteria were 305. NFLG AS was less common (18 %). Patients in the C-LFLG AS had similar mortality (hazard ratio (HR) = 1.07, 95 % confidence interval (CI) 0.64-1.80), and heart failure rehospitalization (HR = 1.31, CI 0.69-2.48) rates 3 years post-TAVR, compared to patients with low LVEF NFLG AS. End-stage renal disease was associated with NFLG AS, whereas diabetes predicted C-LFLG AS.

Conclusions: Mortality after TAVR was similar in patients with low-gradient severe AS and LV systolic dysfunction regardless of flow.

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血流对接受TAVR的左室收缩功能不全患者预后的影响。

背景：与医学治疗相比，TAVR与典型低流量低梯度主动脉狭窄（C-LFLG AS）和正常流量低梯度主动脉狭窄（NFLG AS）患者的预后更好相关。左心室射血分数（LVEF）预测TAVR患者的死亡率。然而，基于低LVEF患者接受TAVR的血流结果仍不清楚。目的：本研究探讨LVEF减少患者行TAVR合并C-LFLG AS和NFLG AS的结果。研究还探讨了这些人群tavr后的血流动力学变化，并确定了决定其预后的因素。方法：回顾性、单中心研究，纳入305例重度AS患者，将患者分为2组：1)C-LFLG AS、AV平均梯度（MG） 2、LVEF 2、LVEF。结果：2600例TAVR患者中，符合纳入标准的低LVEF患者有305例。NFLG AS较少见（18%）。与低LVEF NFLG AS患者相比，C-LFLG AS患者在tavr后3年的死亡率(风险比（HR) = 1.07, 95%可信区间（CI） 0.64-1.80）和心力衰竭再住院率（HR = 1.31, CI 0.69-2.48）相似。终末期肾脏疾病与NFLG AS相关，而糖尿病预测C-LFLG AS。结论：低梯度严重AS和左室收缩功能障碍患者TAVR后的死亡率相似，无论血流如何。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Revascularization Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.30

自引率

5.90%

发文量

687

审稿时长

36 days

期刊介绍： Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.