Guy Witberg; Amos Levi; Yeela Talmor-Barkan; Marco Barbanti; Roberto Valvo; Giuliano Costa; Valentina Frittitta; Ole De Backer; Yannick Willemen; Mark van den Dorpel; Matias Mon; Atsushi Sugiura; Mitsumasa Sudo; Giulia Masiero; Edoardo Pancaldi; Dabit Arzamendi; Sandra Santos-Martinez; Jose  A. Baz; Klemen Steblovnik; Victor Mauri; Matti Adam; Hendrik Wienemann; David Zahler; Manuel Hein; Philipp Ruile; Brídóg  Nic Aodha; Carmelo Grasso; Luca Branca; Rodrigo Estevez-Loureiro; Ignacio  J. Amat-Santos; Darren Mylotte; Matjaz Bunc; Giuseppe Tarantini; Luis Nombela-Franco; Lars Søndergaard; Nicolas M. van Mieghem; Ariel Finkelstein; Ran Kornowski

doi:10.4244/EIJ-D-23-00948

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

Guy Witberg¹, MD, MPH; Amos Levi¹, MD; Yeela Talmor-Barkan¹, MD, PhD; Marco Barbanti²^,³, MD; Roberto Valvo³, MD; Giuliano Costa³, MD; Valentina Frittitta³, MD; Ole De Backer⁴, MD, PhD; Yannick Willemen⁴, MD; Mark van den Dorpel⁵, MD; Matias Mon⁶, MD; Atsushi Sugiura⁷, MD; Mitsumasa Sudo⁷, MD; Giulia Masiero⁸, MD; Edoardo Pancaldi⁹, MD; Dabit Arzamendi¹⁰, MD, PhD; Sandra Santos-Martinez¹¹, MD; Jose A. Baz¹², MD; Klemen Steblovnik¹³, MD, PhD; Victor Mauri¹⁴, MD; Matti Adam¹⁴, MD; Hendrik Wienemann¹⁴, MD; David Zahler¹⁵, MD; Manuel Hein¹⁶, MD; Philipp Ruile¹⁶, MD; Brídóg Nic Aodha¹⁷, MD; Carmelo Grasso³, MD; Luca Branca⁹, MD; Rodrigo Estévez-Loureiro¹², MD; Ignacio J. Amat-Santos¹¹, MD, PhD; Darren Mylotte¹⁷, MBBCh, MD, PhD; Matjaz Bunc¹³, MD, PhD; Giuseppe Tarantini⁸, MD, PhD; Luis Nombela-Franco⁶, MD, PhD; Lars Sondergaard⁴, MD; Nicolas M. van Mieghem⁵, MD, PhD; Ariel Finkelstein¹⁵, MD; Ran Kornowski¹, MD

Abstract

BACKGROUND: Data on the likelihood of left ventricle (LV) recovery in patients with severe LV dysfunction and severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and its prognostic value are limited.

AIMS: We aimed to assess the likelihood of LV recovery following TAVI, examine its association with midterm mortality, and identify independent predictors of LV function.

METHODS: In our multicentre registry of 17 TAVI centres in Western Europe and Israel, patients were stratified by baseline LV function (ejection fraction [EF] >/≤30%) and LV response: no LV recovery, LV recovery (EF increase ≥10%), and LV normalisation (EF ≥50% post-TAVI).

RESULTS: Our analysis included 10,872 patients; baseline EF was ≤30% in 914 (8.4%) patients and >30% in 9,958 (91.6%) patients. The LV recovered in 544 (59.5%) patients, including 244 (26.7%) patients whose LV function normalised completely (EF >50%). Three-year mortality for patients without severe LV dysfunction at baseline was 29.4%. Compared to this, no LV recovery was associated with a significant increase in mortality (adjusted hazard ratio 1.32; p<0.001). Patients with similar LV function post-TAVI had similar rates of 3-year mortality, regardless of their baseline LV function. Three variables were associated with a higher likelihood of LV recovery following TAVI: no previous myocardial infarction (MI), estimated glomerular filtration rate >60 mL/min, and mean aortic valve gradient (mAVG) (expressed either as a continuous variable or as a binary variable using the standard low-flow, low-gradient aortic stenosis [AS] definition).

CONCLUSIONS: 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. (ClinicalTrials.gov: NCT04031274)

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