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. 2024 Jul 19;6(4):271-277.
doi: 10.24875/RECIC.M24000465. eCollection 2024 Oct-Dec.

[Prognosis of patients with supranormal ejection fraction undergoing percutaneous aortic valve replacement]

[Article in Spanish]
Edgar Martínez Gómez  1 , Ximena Solar  1 , Daniel Faria  2 , Luis Nombela Franco  2 , Pilar Jiménez Quevedo  2 , Gabriela Tirado  2 , Eduardo Pozo Osinalde  1 , Carmen Olmos Blanco  1 , Patricia Mahía Casado  1 , Pedro Marcos Alberca  1 , María Luaces  1 , José Juan Gómez de Diego  1 , Luis Collado Yurrita  3 , Antonio Fernández-Ortiz  1 , Julián Pérez-Villacastín  1 , José Alberto de Agustín  1
Affiliations

[Prognosis of patients with supranormal ejection fraction undergoing percutaneous aortic valve replacement]

[Article in Spanish]
Edgar Martínez Gómez et al. REC Interv Cardiol. .

Abstract
in English, Spanish

Introduction and objectives: Several studies have shown that reduced (< 50%) left ventricular ejection fraction (LVEF) is an independent risk factor for cardiovascular events and mortality in patients with severe aortic stenosis (AS) undergoing valve replacement. Although patients with preserved LVEF (> 50%) have a better prognosis, there is a group with supranormal LVEF (≥ 70%) whose prognosis seems to differ due to their characteristics. The aim of this study was to evaluate outcomes after transcatheter aortic valve implantation (TAVI) in patients with severe AS and supranormal LVEF.

Methods: We performed a retrospective cohort study that included 1160 patients undergoing TAVI between 2007 and 2021 at Hospital Clínico San Carlos (Madrid, Spain). The patients were classified according to preoperative LVEF into reduced (< 50%), normal (50% to 69%), and supranormal (≥ 70%). Clinical, echocardiographic variables, and the following outcomes were compared: death from any cause at 30 days and at 1 year, death from cardiovascular causes at 1 year, and rehospitalization due to cardiovascular causes at 1 year.

Results: Of the 1160 patients with severe AS who underwent TAVI during the study period, 276 (23.8%) had reduced LVEF, 702 (60.5%) had normal LVEF, and 182 (15.7%) had supranormal LVEF. Patients with supranormal LVEF were predominantly men (82.9 ± 5.3 years) and had lower ventricular volumes, higher relative wall thickness, and concentric geometry. There were no differences in 30-day or 1-year mortality. However, rehospitalization for cardiovascular causes at 1 year was significantly higher in the supranormal LVEF group (LVEF < 50%: 29.2%; LVEF 50% to 69%: 27.4%; LVEF ≥ 70%: 34.4%; P < .043).

Conclusions: Patients with severe AS and supranormal preprocedural LVEF (≥ 70%) who underwent TAVI had a higher rate of cardiovascular rehospitalization at 1 year, with no differences in mortality.

Introducción y objetivos:: Se ha evidenciado en diversos estudios que la fracción de eyección del ventrículo izquierdo (FEVI) reducida (< 50%) es un factor de riesgo independiente de eventos y mortalidad en pacientes con estenosis aórtica (EA) grave tratados con recambio valvular. A pesar de que aquellos con FEVI conservada (> 50%) muestran mejor pronóstico, existe un grupo con FEVI supranormal (≥ 70%) que parece tener un pronóstico diferente por sus características particulares. El objetivo de este estudio fue evaluar los resultados del implante percutáneo de válvula aórtica (TAVI) en pacientes con EA grave y FEVI supranormal.

Métodos:: Estudio de cohorte retrospectiva que incluyó 1.160 pacientes tratados con TAVI en 2007-2021 en el Hospital Clínico San Carlos (Madrid, España). Se clasificaron según su FEVI preoperatoria en reducida (< 50%), normal (50-69%) y supranormal (≥ 70%). Se compararon variables clínicas y ecocardiográficas, y los siguientes desenlaces: mortalidad por cualquier causa a los 30 días y al año, muerte por causa cardiovascular al año y rehospitalización por causa cardiovascular al año.

Resultados:: De los 1.160 pacientes con EA grave que recibieron un TAVI durante el periodo del estudio, 276 (23,8%) se registraron con FEVI reducida, 702 (60,5%) con FEVI normal y 182 (15,7%) con FEVI supranormal. Los pacientes con FEVI supranormal eran predominantemente varones (82,9 ± 5,3 años), tenían menores volúmenes ventriculares, mayor grosor parietal relativo y geometría concéntrica. No hubo diferencias en la mortalidad a 30 días ni al año; sin embargo, la rehospitalización por causa cardiovascular al año fue significativamente superior en el grupo de FEVI supranormal (FEVI < 50%, 9,2%; FEVI 50-69%, 27,4%; FEVI ≥ 70%, 34,4%; p < 0,043).

Conclusiones:: Los pacientes con EA grave tratados con TAVI que presentaban FEVI supranormal (≥ 70%) preprocedimiento tuvieron una mayor tasa de rehospitalización por causa cardiovascular al año, sin diferencias en la mortalidad.

Keywords: Rehospitalization; Severe aortic stenosis; Supranormal ejection fraction; TAVI.

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Conflict of interest statement

CONFLICTO DE INTERESES: No hay conflicto de intereses.

Figures

Figura 1
Figura 1. Flow chart indicando los pacientes incluidos y excluidos en el estudio, así como la muestra final analizada y su distribución en los 3 grupos de estudio. FEVI: fracción de eyección del ventrículo izquierdo.
Figure 1
Figure 1. Flow chart illustrating the patients included and excluded from the study, the final sample analyzed, and its distribution among the 3 study groups. LVEF, left ventricular ejection fraction.
See this image and copyright information in PMC

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