Impact of baseline left ventricular ejection fraction on thirty-day and one-year mortality after transfemoral aortic valve implantation
Data on the impact of baseline left ventricular ejection fraction (LVEF) on outcome after transcatheter aortic valve implantation (TAVI) are inconsistent, and there is a potential confounding effect of a low transvalvular aortic gradient (< 40 mmHg = LGAS). Moreover, the cutoff points to define an impaired LVEF in previous TAVI studies are rather arbitrary. We, therefore, studied the impact of the recommendations of the American Society of Echocardiography and the European Association of Cardiovascular Imaging for classification of an impaired LVEF on the 30-day and 1-year mortality in patients with severe symptomatic aortic stenosis who underwent transfemoral (TF-) TAVI. The impact of a LGAS was also evaluated. Baseline LVEF was normal in 280 (55%), mildly abnormal in 121 (24%), moderately abnormal in 74 (15%) and severely abnormal in 30 (6%) patients, respectively. Thirty-day and 1-year mortality were 8.5% and 22.4%, respectively, and patients with a normal or mildly abnormal LVEF (> 40%) had similar outcomes. However, mortality was increased in patients with a moderately or severely abnormal LVEF (≤ 40%), especially in the presence of LGAS. Patients with a moderately or severely abnormal LVEF and a LGAS exhibited nearly a 2-fold higher 1-year mortality (40.3%) compared to any other patient subgroup. In the multivariate analysis, the combination of a moderately or severely abnormal LVEF and a LGAS predicted an increased 30-day (hazard ratio 3.33, 95% CI 1.76 to 6.3) and 1-year mortality (hazard ratio 2.42, 95% CI 1.57 to 3.72). We concluded that a moderately or severely abnormal LVEF at baseline is associated with an increased mortality after TF-TAVI when the mean transvalvular aortic gradient is less than 40 mmHg, while outcomes in patients with a normal and mildly abnormal LVEF are comparable regardless the transvalvular aortic gradient.