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Clinical Trial
. 2022 Sep:42:55-61.
doi: 10.1016/j.carrev.2022.02.023. Epub 2022 Feb 26.

Impact of First-Phase Ejection Fraction on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation

Daijiro Tomii  1 , Taishi Okuno  1 , Caglayan Demirel  1 , Fabien Praz  1 , Jonas Lanz  1 , Stefan Stortecky  1 , Stephan Windecker  1 , Thomas Pilgrim  2
Affiliations
Free article
Clinical Trial

Impact of First-Phase Ejection Fraction on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation

Daijiro Tomii et al. Cardiovasc Revasc Med. 2022 Sep.
Free article

Abstract

Background: First-phase left ventricular ejection fraction (LVEF1) is an early marker of left ventricular remodeling. Reduced LVEF1 has been associated with adverse prognosis in patients with aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF). It remains to be determined, whether reduced LVEF1 differentiates clinical outcomes after aortic valve replacement.

Objectives: We investigated the impact of LVEF1 on clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) for symptomatic severe AS with preserved LVEF (≥ 50%).

Methods: In the prospective Bern TAVI registry, we retrospectively categorized patients according to LVEF1 as assessed by transthoracic echocardiography. Clinical outcomes of interest were all-cause mortality and residual heart failure symptoms (New York Heart Association (NYHA) functional class III or IV) at 1 year after TAVI.

Results: A total of 644 patients undergoing TAVI between January 2014 and December 2019 were included in the present analysis. Patients with low LVEF1 had a lower LVEF (62.0 ± 6.89% vs. 64.3 ± 7.82%, P < 0.001) and a higher left ventricular mass index (129.3 ± 39.1 g/m2 vs. 121.5 ± 38.0 g/m2; P = 0.027) compared to patients with high LVEF1. At 1 year, the incidence of all-cause/cardiovascular death, and NYHA III or IV were comparable between patients with low and high LVEF1 (8.3% vs. 9.2%; P = 0.773, 3.9% vs. 6.0%; P = 0.276, 12.9% vs. 12.2%; P = 0.892, respectively).

Conclusions: Reduced LVEF1 was not associated with adverse clinical outcomes following TAVI in patients with symptomatic severe AS with preserved LVEF.

Clinical trial registration: https://www.

Clinicaltrials: gov. NCT01368250.

Keywords: Aortic stenosis; First-phase ejection fraction; Left ventricular ejection fraction; Left ventricular remodeling; Transcatheter aortic valve replacement.

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Conflict of interest statement

Declaration of competing interest Dr. Windecker reports research and educational grants to the institution from Abbott, Amgen, Astra Zeneca, BMS, Bayer, Biotronik, Boston Scientific, Cardinal Health, CardioValve, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Guerbet, InfraRedx, Johnson & Johnson, Medicure, Medtronic, Novartis, Polares, OrPha Suisse, Pfizer, Regeneron, Sanofi-Aventis, Sinomed, Terumo, V-Wave. Dr. Windecker serves as unpaid advisory board member and/or unpaid member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, Astra Zeneca, BMS, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, Med Alliance, Medtronic, Novartis, Polares, Sinomed, V-Wave and Xeltis, but has not received personal payments by pharmaceutical companies or device manufacturers. He is also member of the steering/executive committee group of several investigator-initiated trials that receive funding by industry without impact on his personal remuneration. Dr. Pilgrim reports research grants to the institution from Edwards Lifesciences, Boston Scientifc and Biotronik, personal fees from Biotronik and Boston Scientific, and other from HighLife SAS and Medira. Dr. Pilgrim is a proctor for Medtronic. Dr. Stortecky reports research grants to the institution from Edwards Lifesciences and Medtronic, and personal fees from Boston Scientific, Teleflex, and BTG. Dr. Praz reports travel expenses from Abbott, Edwards Lifesciences, and Polares Medical. Dr. Okuno reports speaker fees from Abbott. All other authors have no relationships relevant to the contents of this article to disclose.

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