Reduced LVEF before TAVR linked to lower long-term survival rate
Patients with severe aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF) are associated with worse long-term transcatheter aortic valve replacement (TAVR) outcomes, according to new findings published in The American Journal of Cardiology.[1]
Reduced LVEF is already largely seen as a considerable risk factor when patients undergo TAVR. However, the study’s authors noted, research specifically focused on how LVEF impacts patient outcomes has been inconsistent.
“Despite being a well-known risk factor for impaired survival, the relationship between reduced LVEF and increased mortality in the setting of patients treated with TAVR has been questioned during the years,” wrote first author Francesco De Felice, MD, an interventional cardiologist with San Camillo Forlanini Hospital in Rome, Italy, and colleagues.
Hoping to learn more, the group tracked data from more than 2,500 TAVR patients who received a self-expanding Medtronic TAVR valve in Italy from 2007 to 2017. The median patient age was 82 years old, and 56.5% of patients were women. While 68.1% presented with normal LVEF, the other 31.9% presented with reduced LVEF. Median LVEFs were 59% for the normal LVEF group and 38% for the reduced LVEF group.
The study’s median follow-up period was 39 months, though data for up to 75 months after treatment were available for some patients. Researchers then used Kaplan-Meier estimates to chart eight-year outcomes.
Overall, the authors did confirm that reduced LVEF was an independent predictor of worse clinical outcomes. Other independent predictors included age, New York Heart Association class and a history of pulmonary hypertension, peripheral vascular disease or chronic obstructive pulmonary disease.
After eight years, the study’s primary endpoint—a composite of all-cause death and cardiac rehospitalizations—was estimated to be 82.1% for the normal LVEF group and 88.4% for the reduced LVEF group. The same trend was also seen when tracking all-cause death (74.5% vs. 80.1%) or cardiac rehospitalizations (40.9% vs. 51.1%) on their own.
“Our study demonstrated that reduced LVEF is significantly associated with impaired outcomes following TAVR at eight years of follow-up,” the group wrote. “Future prospective studies involving systematic evaluation of pre-/post- TAVR left ventricular function as well as the interaction between modern treatment strategies of reduced LVEF and AS interventions are needed to address the currently unsolved issues on this topic.”
Click here to read the full analysis in The American Journal of Cardiology.[1]
Multiple co-authors did report prior relationships with Medtronic, Edwards Lifesciences, Abbott and Boston Scientific.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.