Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation

Witberg, G; Levi, A; Talmor-Barkan, Y; Barbanti, M; Valvo, R; Costa, G; Frittitta, V; de Backer, O; Willemen, Y; van den Dorpel, M; Mon, M; Sugiura, A; Sudo, M; Masiero, G; Pancaldi, E; Arzamendi, D; Santos-Martinez, S; Baz, JA; Steblovnik, K; Mauri, V; Adam, M; Wienemann, H; Zahler, D; Hein, M; Ruile, P; Aodha, BN; Grasso, C; Branca, L; Estévez-Loureiro, R; Amat-Santos, IJ; Mylotte, D; Bunc, M; Tarantini, G; Nombela-Franco, L; Sondergaard, L; Van Mieghem, NM; Finkelstein, A; Kornowski, R

doi:10.4244/eij-d-23-00948

Valvular & structural heart disease

Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation

EuroInterventionPublished 15 Apr 2024Multicentre registry study

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Authors' conclusion

LV recovery following TAVI and the extent of this recovery are major determinants of midterm mortality in patients with severe AS and severe LV dysfunction undergoing TAVI. Patients with no previous MI and those with an mAVG >40 mmHg show the best results following TAVI, which are at least equivalent to those for patients without severe LV dysfunction.

Study context

Population: Patients with severe AS undergoing transcatheter aortic valve implantation (TAVI), stratified by baseline EF (>/≤30%)914 (8.4%) with EF ≤30%
Participants: 10,872 patients

Exposure: LV response after TAVI (no LV recovery, LV recovery, LV normalisation) in severe LV dysfunction vs no severe LV dysfunction
EF >30%n = 9,958reference
LV recoveryn = 544
LV normalisationn = 244
Outcome: LV recovery following TAVI and its association with mortality
Follow-up: 3 years

Methodological details17 TAVI centres in Western Europe and Israel

17 TAVI centres in Western Europe and Israel

Main finding

As reported in the abstract

LV recovery (baseline EF ≤30%)

LV recovery59.5%544

LV normalisation26.7%244

Observational data: associations, not effects.

Further findings

Outcome	EF >30%	Adjusted HR	P value
3-year mortality · 3 yearsNo LV recovery vs EF >30%	29.4%	1.32	P < 0.001

3-year mortality

Patients with similar LV function post-TAVI had similar 3-year mortality, regardless of baseline LV function

Predictors of LV recovery

Higher likelihood of LV recovery with no previous myocardial infarction (MI), eGFR >60 mL/min, and mean aortic valve gradient (continuous or low-flow, low-gradient AS definition)

Reference

Authors: Witberg G, Levi A, Talmor-Barkan Y, Barbanti M, Valvo R, Costa G, et al.
All 38 authors
Witberg G, Levi A, Talmor-Barkan Y, Barbanti M, Valvo R, Costa G, Frittitta V, de Backer O, Willemen Y, van den Dorpel M, Mon M, Sugiura A, Sudo M, Masiero G, Pancaldi E, Arzamendi D, Santos-Martinez S, Baz JA, Steblovnik K, Mauri V, Adam M, Wienemann H, Zahler D, Hein M, Ruile P, Aodha BN, Grasso C, Branca L, Estévez-Loureiro R, Amat-Santos IJ, Mylotte D, Bunc M, Tarantini G, Nombela-Franco L, Sondergaard L, Van Mieghem NM, Finkelstein A, Kornowski R
Journal: EuroIntervention
Published: 15 Apr 2024
DOI: 10.4244/eij-d-23-00948
PubMed: 38629416
Registration: NCT04031274

Topic: Valvular & structural heart disease
Also indexed: Interventional cardiology

Exposure definitions

LV recovery: baseline EF ≤30% with EF increase ≥10%
LV normalisation: EF ≥50% post-TAVI

Original publication

Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation. EuroIntervention. Published 15 April 2024. doi:10.4244/eij-d-23-00948

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