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

被引：4

作者：

Witberg, Guy ^{[1
,2
]}

Levi, Amos ^{[1
,2
]}

Talmor-Barkan, Yeela ^{[1
,2
]}

Barbanti, Marco ^{[3
,4
]}

Valvo, Roberto ^{[4
]}

Costa, Giuliano ^{[4
]}

Frittitta, Valentina ^{[4
]}

de Backer, Ole ^{[5
]}

Willemen, Yannick ^{[5
]}

van den Dorpel, Mark ^{[6
]}

Mon, Matias ^{[7
]}

Sugiura, Atsushi ^{[8
]}

Sudo, Mitsumasa ^{[8
]}

Masiero, Giulia ^{[9
]}

Pancaldi, Edoardo ^{[10
]}

Arzamendi, Dabit ^{[11
]}

Santos-Martinez, Sandra ^{[12
]}

Baz, Jose A. ^{[13
]}

Steblovnik, Klemen ^{[14
]}

Mauri, Victor ^{[15
]}

Adam, Matti ^{[15
]}

Wienemann, Hendrik ^{[15
]}

Zahler, David ^{[16
,17
]}

Hein, Manuel ^{[18
]}

Ruile, Philipp ^{[18
]}

Aodha, Bridog Nic ^{[19
,20
]}

Grasso, Carmelo ^{[4
]}

Branca, Luca ^{[10
]}

Estevez-Loureiro, Rodrigo ^{[13
]}

Amat-Santos, Ignacio J. ^{[12
]}

Mylotte, Darren ^{[19
,20
]}

Bunc, Matjaz ^{[14
]}

Tarantini, Giuseppe ^{[9
]}

Nombela-Franco, Luis ^{[7
]}

Sondergaard, Lars ^{[5
]}

Van Mieghem, Nicolas M. ^{[6
]}

Finkelstein, Ariel ^{[16
,17
]}

Kornowski, Ran ^{[1
,2
]}

机构：

[1] Rabin Med Ctr, Dept Cardiol, 39 Jabutinski St, IL-98100 Petah Tiqwa, Israel

[2] Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel

[3] Univ Enna Kore, Enna, Italy

[4] Univ Catania, Div Cardiol, Catania, Italy

[5] Copenhagen Univ Hosp, Rigshosp, Heart Ctr, Copenhagen, Denmark

[6] Erasmus MC, Thoraxctr, Dept Cardiol, Rotterdam, Netherlands

[7] Hosp Clin San Carlos, IdISSC, Cardiovasc Inst, Madrid, Spain

[8] Herzzentrum Bonn Univ Klinikum, Bonn, Germany

[9] Univ Padua, Dept Cardiac Thorac & Vasc Sci, Med Sch, Padua, Italy

[10] Spedali Civili Brescia, Cardiovasc Dept, Brescia, Italy

[11] Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain

[12] Hosp Clin Univ Valladolid, CIBERCV, Valladolid, Spain

[13] Hosp Alvaro Cunqueiro, Serv Cardiol, Vigo, Pontevedra, Spain

[14] Univ Med Ctr Ljubljana, Dept Cardiol, Ljubljana, Slovenia

[15] Univ Cologne, Fac Med, Heart Ctr, Dept Cardiol, Cologne, Germany

[16] Tel Aviv Sourasky Med Ctr, Tel Aviv, Israel

[17] Tel Aviv Univ, Sch Med, Tel Aviv, Israel

[18] Univ Heart Ctr Freiburg Bad Krozingen, Dept Cardiol & Angiol 2, Bad Krozingen, Germany

[19] Galway Univ Hosp, Dept Cardiol, Galway, Ireland

[20] Univ Galway, Galway, Ireland

来源：

EUROINTERVENTION | 2024年 / 20卷 / 08期

关键词：

LOW-GRADIENT; EJECTION FRACTION; CARDIAC DAMAGE; LOW-FLOW; STENOSIS; REPLACEMENT; IMPACT;

D O I：

10.4244/EIJ-D-23-00948

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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, lowgradient 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)

引用

页码：E487 / +

页数：11

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