The following is a summary of “Echocardiographic predictors of outcome in severe aortic stenosis patients with preserved or reduced ejection fraction,” published in the January 2024 issue of Cardiology by Sokalski et al.
Transcatheter aortic valve implantation (TAVI) has become the preferred treatment for numerous individuals experiencing severe symptomatic aortic stenosis.
Researchers conducted a retrospective study to discern echocardiographic factors that could predict the 30-day and 1-year outcomes following TAVI in patients with either preserved or reduced left ventricular ejection fraction (LVEF).
They involved 618 patients with aortic stenosis (mean age 82 ± 6 years, 47.1% male; 74.8% LVEF > 50%) who underwent balloon-expandable TAVI at our hospital (from July 2009 to October 2018). All participants completed at least 6 months of follow-up through medical history reviews or telephone interviews (median 24 months, quartiles 12–42). The primary endpoint assessed was all-cause death.
The results showed that the all-cause mortality rate was 5.2% (LVEF > 50%: 4.3% vs. LVEF ≤ 50%: 7.7%, P=0.141) at 30 days and 15.4% (LVEF > 50%: 14.7% vs. LVEF ≤ 50%: 17.3%, P=0.443) at 12 months post TAVI. The overall all-cause mortality rate was 45.1% (LVEF > 50%: 44.6% vs. LVEF ≤ 50%: 46.8%, P=0.643). The mean survival time post TAVI was 51 months [95% CI (48; 55)]. Among TAVI patients with LVEF > 50%, multivariate Cox regression analysis identified independent predictors for increased death risk, adjusting for echocardiographic and clinical covariates; TAPSE (≤ 17 verses > 17 mm, HR 1.528, P=0.016) and sPAP (> 30 vs. ≤ 30 mmHg, HR 1.900, P=0.002) for overall mortality, E/E′ septal for 30-day mortality (> 21 vs. ≤ 21, HR 14.462, P=0.010) and 12-month mortality (> 21 vs. ≤ 21, HR 1.881, P=0.026). In TAVI patients with LVEF ≤ 50%, no independent echocardiographic predictors for outcome could be identified.
They concluded that LVEF proves insignificant in predicting short- and long-term mortality post-TAVI; however, preserved LVEF patients exhibit increased mortality risk associated with elevated left ventricular filling pressure (E/E’), systolic pulmonary artery pressure (sPAP), and reduced TAPSE.
Source: link.springer.com/article/10.1007/s00392-023-02350-w