BACKGROUND: Impaired left ventricular function is associated with
worse prognosis among patients with aortic stenosis treated medically or
with surgical aortic valve replacement. It is unclear whether reduced left
ventricular ejection fraction (LVEF) is an independent predictor of adverse
outcomes after transcatheter aortic valve replacement.
METHODS AND RESULTS: Patients who underwent transcatheter
aortic valve replacement in the PARTNER 2 trials (Placement of Aortic
Transcatheter Valves) and registries were stratified according to presence
of reduced LVEF (<50%) at baseline, and 2-year risk of cardiovascular
mortality was compared using Kaplan–Meier methods and multivariable
Cox proportional hazards regression. Of 2991 patients, 839 (28%)
had reduced LVEF. These patients were younger, more often males,
and were more likely to have comorbidities, such as coronary disease,
diabetes mellitus, and renal insufficiency. Compared with patients with
normal LVEF, patients with low LVEF had higher crude rates of 2-year
cardiovascular mortality (19.8% versus 12.0%, P<0.0001) and all-cause
mortality (27.4% versus 19.2%, P<0.0001). Mean aortic valve gradient
was not associated with clinical outcomes other than heart failure
hospitalizations (hazard ratio [HR], 0.99; CI, 0.99–1.00; P=0.03). After
multivariable adjustment, patients with reduced versus normal LVEF had
significantly higher adjusted risk of cardiovascular death (adjusted HR,
1.42, 95% CI, 1.11–1.81; P=0.005), but not all-cause death (adjusted
HR, 1.20; 95% CI, 0.99–1.47; P=0.07). When LVEF was treated as
continuous variable, it was associated with increased 2-year risk of both
cardiovascular mortality (adjusted HR per 10% decrease in LVEF, 1.16;
95% CI, 1.07–1.27; P=0.0006) and all-cause mortality (adjusted HR, 1.09;
95% CI, 1.01–1.16; P=0.02).
CONCLUSIONS: In this patient-level pooled analysis of PARTNER 2
patients who underwent transcatheter aortic valve replacement, baseline
LVEF was an independent predictor of 2-year cardiovascular mortality.
CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov.
Unique identifiers: NCT01314313, NCT02184442, NCT03222128, and
NCT02184441.
Tags: EF, heart failure, TAVR