Prognostic Significance of Change in the Left Ventricular Ejection Fraction After Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis and Left Ventricular Dysfunction

Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared with patients with preserved LVEF. To evaluate the impact of early LVEF recovery in patients with baseline dysfunction on clinical outcomes after transcatheter aortic valve implantation (TAVI), we included all consecutive patients who underwent TAVI from the Italian ClinicalService registry with an LVEF of ≤45% at baseline who had 1-month LVEF data. Patients who experienced a previous coronary artery bypass graft, a previous valve replacement, or a previous myocardial infarction were excluded from the analysis. Therefore, 131 patients with an improvement in LVEF of <10% (no-R group) were compared with 121 patients with an improvement in LVEF of ≥10% (R group). The primary end point was the rate of death of any cause. Multivariable analysis was performed to determine independent predictors of lack in LVEF recovery. Early LVEF recovery occurred in 48% of the patients, generally before discharge. One-year all-cause mortality and major adverse cardiac and cerebrovascular events were significantly higher in the no-early recovery group (log rank test p = 0.005 and p = 0.003, respectively). Baseline severe left ventricular dysfunction and previous percutaneous coronary intervention were identified as independent predictors to warn the lack of improvement in LVEF. In conclusion, nearly 50% of patients with preoperative left ventricular dysfunction demonstrated a significant early improvement in LVEF after TAVI. Lack of early LVEF recovery is associated with a worse clinical outcome and is most likely among patients with a severely abnormal baseline LVEF and a previous percutaneous coronary intervention.