Ejection Fraction and Aortic Valve Gradient in TAVR

Jun 03, 2016
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Authors:
Baron SJ, Arnold SV, Herrmann, HC, et al.
Citation:
Impact of Ejection Fraction and Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2016;67:2349-2358.
Summary By:
Troy M LaBounty, MD, FACC

Study Questions:

What are the effects of left ventricular ejection fraction (LVEF) and aortic valve gradients (AVGs) on outcomes following transcatheter aortic valve replacement (TAVR)?

Methods:

This study examined data from 11,292 patients treated with TAVR and enrolled in a national registry, and compared mortality and heart failure at 1 year in patients stratified by LVEF and high (≥40 mm Hg) versus low mean AVG.

Results:

During follow-up, decreased LVEF and low AVG at baseline were both associated with increased mortality and recurrent heart failure. On multivariable analysis, low baseline AVG was associated with increased mortality (hazard ratio [HR], 1.2; 95% confidence interval [CI], 1.1-1.3; p < 0.001) and increased recurrent heart failure (HR, 1.5; 95% CI, 1.4-1.7; p < 0.001), although reduced LVEF was not independently associated with either adverse event.

Conclusions:

In patients treated with TAVR, a low baseline AVG identifies patients at increased risk of mortality and recurrent heart failure.

Perspective:

Low-flow, low-gradient severe aortic stenosis has gained increased attention over the past few years, and patients with this hemodynamic profile appear to have a worse prognosis than individuals with high-gradient severe aortic stenosis. This large study finds that a low mean AVG—but not low EF—is an important predictor of increased risk of mortality and recurrent heart failure. These results are consistent with prior literature in TAVR and surgical AVR. A key goal in treatment of severe aortic stenosis is to improve our identification of patients most likely to benefit from valve replacement. While these findings should not prevent us from intervening on patients with low AVG, it helps us improve our understanding of the risks and potential outcomes following TAVR.

Keywords: Aortic Valve, Aortic Valve Stenosis, Cardiac Surgical Procedures, Heart Failure, Heart Valve Diseases, Hemodynamics, Mortality, Outcome Assessment, Health Care, Stroke Volume, Transcatheter Aortic Valve Replacement, Ventricular Function, Left


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