Key result
Transcatheter aortic valve replacement resulted in similar all-cause mortality across baseline LVEF subgroups (28.1%, 29.5%, 22.5%, and 24.1%; p=0.44), with significant early LVEF improvement.
Why the study?
The study aimed to assess the prognostic effects of TAVR and LV remodelling across the range of left ventricular systolic function in patients with severe symptomatic aortic stenosis.
Does baseline LVEF and its early recovery after TAVR predict survival in patients with severe symptomatic aortic stenosis?
Cohort (n=495)
Yes
Does baseline LVEF and its early recovery after TAVR predict survival in patients with severe symptomatic aortic stenosis?
p-value: p=0.44
TAVR provides survival benefits across all ranges of baseline left ventricular systolic function, and early post-procedural LVEF recovery is a critical predictor of survival, particularly in patients with advanced heart failure.
TAVR prognostic associations by LVEF strata remain hypothesis-generating; prospective trials needed before guiding practice.
Aims The objective of this study is to assess the prognostic effects of T ranscatheter aortic valve replacement (TAVR) on the patients with different degrees of left ventricular systolic (LVS) function and severe symptomatic aortic stenosis. Also examines the prognostic association of LV remodelling after TAVR.Methods and results Patients stratified into four subgroups with respect to baseline LV ejection fraction (LVEF) (LVEF > 25%, LVEF 25%–40%, LVEF 41%–49% and LVEF ≥ 50%). We compared the baseline characteristics and temporal changes in echocardiographic parameters of the patients after TAVR, and determined all-cause mortality (ACM) in a follow-up period of mean 20.7 ± 15.8 months (up to 84). There were 495 patients at 8 centres. ACM was similar in all groups (28.1%, 29.5%, 22.5% and 24.1% respectively; p = .44). Immediately after TAVR, there was an improvement in LVEF (from 38.7 ± 9.4 to 44.9% ± 10.9%, p < .001). The percent change in LVEF (pDelta-EF) immediately after TAVR was more prominent in the patients with LVEF < 25% (48.1 ± 49.6, 21.9 ± 29.6), (8.4% ± 15.2%) and (2.1 ± 7)) (p < .01). Importantly, a 12% increase in absolute Delta-EF was observed in patients with LVEF< 25% with 100% sensitivity and 42.5% specificity for the prediction of ACM.Conclusion This study shows that TAVR is beneficial in the whole range of LVS function, irrespective of the baseline EF. Early recovery in LVEF after TAVR is critical for survival, however, it seems to be more eye catching in the patients with advanced heart failure with reduced EF.
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Kılıçaslan et al. (2020) conducted a cohort in severe symptomatic aortic stenosis (n=495). Transcatheter aortic valve replacement (TAVR) vs. Different baseline LVEF subgroups was evaluated on all-cause mortality (ACM) (p=0.44). Transcatheter aortic valve replacement resulted in similar all-cause mortality across baseline LVEF subgroups (28.1%, 29.5%, 22.5%, and 24.1%; p=0.44), with significant early LVEF improvement.
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