Incidence, Predictors, and Prognostic Impact of Immediate Improvement in Left Ventricular Systolic Function After Transcatheter Aortic Valve Implantation

https://doi.org/10.1016/j.amjcard.2021.04.037Get rights and content

Immediate improvement in left ventricular ejection fraction (LVEF) following transcatheter aortic valve implantation (TAVI) is common; however, data on the pattern and prognostic value of this improvement are limited. To evaluate the incidence, predictors, and clinical impact of immediate improvement in LVEF, we studied 694 consecutive patient who had underwent successful TAVI for severe aortic stenosis (AS) between March 2010 and December 2019. We defined immediate improvement of LVEF as an absolute increase of ≥5% in LVEF at post-procedure echocardiogram. The primary outcome was major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of death from cardiovascular cause, myocardial infarction, stroke, or rehospitalization from cardiovascular cause. Among them, 160 patients showed immediate improvement in LVEF. The independent predictors of immediate LVEF improvement were absence of hypertension and baseline significant aortic regurgitation, and greater baseline LV mass index. Immediate improvement in LVEF was significantly associated with a lower risk of MACCE (adjusted hazard ratio, 0.48; 95% confidence interval, 0.28–0.81; p = 0.01). In conclusion, approximately one-fourth of patients with severe AS who underwent TAVI showed immediate improvement in LVEF during index hospitalization. Immediate LVEF recovery was associated with a lower risk of MACCE during follow-up.

Section snippets

Methods

The ASAN-TAVR registry is a prospective registry that includes “all-comers” consecutive patients with symptomatic severe AS who undergo TAVI at Asan Medical Center (Seoul, Republic of Korea).6, 7, 8 The traditional surgical risk score was calculated according to the Society of Thoracic Surgeons (STS) score and the Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE).

TAVI was performed under general anesthesia or monitored anesthesia care using standard methods. The

Results

Between March 2010 to December 2019, 700 patients with severe symptomatic AS who underwent TAVI were enrolled in the ASAN-TAVR registry, of which 6 were excluded from the current analysis for the following reasons: Two patients died before post-TAVI echocardiography, 2 underwent conversion to SAVR, and 2 did not receive post-TAVI echo during the index hospitalization. Therefore, 694 patients were included in the final analysis.

Among the 694 eligible patients, 160 (23.1%) demonstrated immediate

Discussion

This study examined the incidence, predictors, and prognostic impact of immediate LVEF recovery in “real-world” patients with severe AS undergoing TAVI; the main findings were as follows: (1) Nearly one-fourth of patients undergoing TAVI had immediate LVEF improvement post-TAVI during the index hospitalization, and this pattern was more prominent in patients with severe LV dysfunction at baseline; (2) absence of hypertension and increased baseline LV mass index were independent predictors of

Author Contributions

Yeong Jin Jeong: Formal analysis, Writing – Original Draft, Review & Editing

Jung-Min Ahn: Conceptualization, Resources, Project administration

Do-Yoon Kang: Resources, Investigation

Hanbit Park: Resources, Investigation

Euihong Ko: Resources, Investigation

Ho Jin Kim: Resources, Investigation

Joon Bum Kim: Resources, Investigation

Suk Jung Choo: Resources, Investigation

Seung-Ah Lee: Resources, Investigation,

Seung-Jung Park: Conceptualization, Resources, Investigation, Methodology, Supervision,

References (29)

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Acknowledgement: This study was partly supported by the CardioVascular Research Foundation (Seoul, Korea). The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

Clinical Trial Registration: http://ClinicalTrials.gov (identifier: NCT03298178)

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