Echocardiographic Determinants of LV Functional Improvement After Transcatheter Aortic Valve Replacement

Background: Transcatheter aortic valve replacement (TAVR) is an established therapy in high-risk patients with severe aortic stenosis. Among patients with reduced left ventricular ejection fraction (LVEF), it is unclear which patients will derive maximal benefit from TAVR. Methods: Clinical and echocardiographic data of patients with severe aortic stenosis and low LVEF (<= 50%) who underwent TAVR at a single institution during 2009-2013 were retrospectively analyzed. Patients were divided into 2 groups post-TAVR based on improved LV function (Group A=Delta LVEF >= 10%) versus persistent LV dysfunction (Group B=Delta LVEF<10%). Echocardiographic parameters were assessed for their association with LVEF change post-TAVR. Kaplan-Meier analysis was performed to generate survival estimates. Results: Of 382 patients who underwent TAVR, 60 patients had low LVEF, LV function failed to improve >= 10% in 50% of patients following the procedure (Group B). At baseline echocardiograms, Group B had higher LVEF, stroke volume (SV), SV index; and lower E, E/E', and estimated pulmonary arterial systolic pressure (PASP) compared to Group A. Higher mortality was found in Group B compared to the Group A (p=0.003) with a significantly shorter survival (Group A=3.3 +/- 0.1years vs Group B=2.7 +/- 0.2years, p=0.003). One-year event free survival was 53.3% in Group B compared to 93.3% in Group A, with a stable trend over ensuing years (5-year survival; 53.3% versus 90.0%, p=0.003). Conclusions: In patients undergoing TAVR with depressed LV function, those who failed to improve were more likely to have relatively higher LVEF, SV, and SVI; and lower E, E/E', and PASP at baseline. Mortality rates were found to be higher in persistent LV dysfunction group. (C) 2015 Wiley Periodicals, Inc.