Impact of baseline left ventricular ejection fraction on outcome after transfemoral transcatheter aortic valve implantation in patients with and without low-gradient aortic stenosis
Karim El-Chilali MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorPolykarpos Christos Patsalis MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorFadi Al-Rashid MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorHeike Annelie Kahlert MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorMatthias Riebisch MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorRaluca-Ileana Mincu PhD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorMatthias Totzeck MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorAlexander Lind MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorRolf Alexander Jánosi MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorClemens Kehren MD
Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorDaniel Dirkmann MD
Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorJürgen Peters MD
Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorDaniel Wendt MD
Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorHeinz Jakob MD
Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorTienush Rassaf MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorCorresponding Author
Philipp Kahlert FAHA, FACC, FSCAI, FESC
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Correspondence
Philipp Kahlert, FAHA, FACC, FSCAI, FESC, Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Essen, Germany.
Email: [email protected]
Search for more papers by this authorKarim El-Chilali MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorPolykarpos Christos Patsalis MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorFadi Al-Rashid MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorHeike Annelie Kahlert MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorMatthias Riebisch MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorRaluca-Ileana Mincu PhD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorMatthias Totzeck MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorAlexander Lind MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorRolf Alexander Jánosi MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorClemens Kehren MD
Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorDaniel Dirkmann MD
Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorJürgen Peters MD
Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorDaniel Wendt MD
Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorHeinz Jakob MD
Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorTienush Rassaf MD
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Search for more papers by this authorCorresponding Author
Philipp Kahlert FAHA, FACC, FSCAI, FESC
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
Correspondence
Philipp Kahlert, FAHA, FACC, FSCAI, FESC, Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Essen, Germany.
Email: [email protected]
Search for more papers by this authorAbstract
Objectives
To evaluate the impact of baseline left ventricular ejection fraction (LVEF) and its interaction with low-gradient aortic stenosis (LGAS) on all-cause mortality after transfemoral aortic valve implantation (TF-TAVI).
Methods
We reviewed mortality data of 624 consecutive single center TF-TAVI patients and categorized LVEF according to current ASE/EACVI recommendations (normal, mildly-, moderately-, and severely abnormal).
Results
Baseline LVEF was normal in 336 (53.8%), mildly abnormal in 160 (25.6%), moderately abnormal in 91 (14.6%), and severely abnormal in 37 (5.9%) patients, and 1-year mortality was 19%, 17%, 23%, and 43% (P = 0.002), respectively. Patients with LGAS had a similar 1-year mortality compared to those without LGAS in groups with normal (19% vs 19%, P = 0.899) and mildly abnormal LVEF (16% vs 17%, P = 0.898). One-year mortality of patients with LGAS was significantly greater than in those without LGAS in presence of moderately abnormal LVEF (31% vs 11%, P = 0.022), and it was numerically greater than in those without LGAS in presence of severely abnormal LVEF (48% vs 25%, P = 0.219). In multivariate analysis, only the combination of moderately/severely abnormal LVEF and LGAS predicted increased 1-year mortality (HR: 2.12, 95% CI: 1.4–3.2, P < 0.001). Other variables, including EuroSCORE I did not affect this result.
Conclusions
Moderately/severely abnormal LVEF (≤40%) at baseline is associated with increased mortality after TF-TAVI, especially when the mean transvalvular aortic gradient is <40 mm Hg (LGAS), while outcomes in patients with normal and mildly abnormal LVEF are comparable regardless of the pressure gradient across the native aortic valve. (DRKS00013729).
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