Baseline left ventricular ejection fraction assessed by cardiac computed tomography in patients undergoing transcatheter aortic valve replacement

Introduction Left ventricular systolic dysfunction has been associated with adverse outcomes after transcatheter aortic valve replacement (TAVR). Patients undergoing TAVR routinely undergo cardiac computed tomography (CCT) to plan the procedure. Left ventricular ejection fraction (LVEF) can be assessed by CCT, but its association with prognosis in patients undergoing TAVR in unclear. Purpose To investigate the association between LVEF assessed by CCT and clinical outcomes after TAVR. Methods We retrospectively assessed baseline LVEF using preprocedural CCT in patients undergoing TAVR. Two groups were identified: (1) patients with an LVEF of <50%, and (2) patients an LVEF of ≥50%. Baseline clinical characteristics, laboratory data, and clinical outcomes were analyzed. The primary endpoint was major adverse cardiac events (MACE) at 1 year, defined as a composite of all-cause mortality, heart failure hospitalization, and stroke. Results A total of 157 consecutive TAVR patients were included in the analysis: median age was 82 (IQR 8) years, and 55% (n=86) of patients were male. Mean LVEF assessed by CCT was 56.3 ±15.1%, and 29% (n=45) of patients had an LVEF <50%. Groups were comparable regarding age and sex. Compared with patients with normal LVEF, patients with low LVEF were more likely to have a history of myocardial infarction (4.5% vs. 17.8%, p=0.01). There were no significant differences regarding other baseline comorbidities and laboratory analysis between groups. Regarding CCT findings, patients with left ventricular dysfunction had a larger LV [indexed LV end-diastolic volume 82 (IQR 26) vs. 108 (IQR 39) ml/m2, p<0.001], and a lower right ventricular ejection fraction [43 (IQR 9) vs. 35 (IQR 13) %, p <0.001]. Regarding prognosis, after 1 year post-TAVR, 13.5% (n=24) of patients experienced the primary endpoint. Rates of MACE did not differ between groups (12.6% vs 15.6%, p=0.63; HR 1.27, 95% CI 0.51-3.15, p=0.61), although patients with an LVEF <50% were numerically at higher risk. When LVEF was treated as continuous variable, it was also not found to be associated with increased 1-year risk of MACE (HR 0.98, 95% CI 0.96–1.01; p=0.16) or all-cause mortality (HR, 0.97; 95% CI 0.93–1.00; p=0.07). Main results are presented in Table 1. Kaplan-Meier survival curves can be seen in Figure 1. Conclusion The assessment of LVEF using preprocedural CCT in patients undergoing TAVR is possible. Baseline LVEF assessed by CCT was not found to be an independent predictor of 1-year MACE after TAVR.