Predictors of lv function recovery one year after TAVR
F Nascimento Ferreira, M Figueiredo, I Rodrigues, M Antunes, T Mendonca, R Ramos, A Fiarresga, R Cruz Ferreira, D CacelaAbstract
Introduction
Transcatheter aortic valve replacement (TAVR) has emerged as an effective treatment for patients with severe aortic stenosis. Although TAVR has been shown to improve left ventricular ejection fraction (LVEF), left ventricular dysfunction, often defined by a reduced LVEF, is a significant predictor of poor outcomes. Identifying factors that predict the maintenance of reduced LVEF (rLVEF) following TAVR is crucial, as persistent LVEF reduction is associated with poorer long-term outcomes.
Objective
To identify pre-procedural predictors of sustained rLVEF in the medium term after TAVR and assess its prognostic impact.
Methods
A retrospective cohort study including patients who underwent echocardiographic re-evaluation one year after TAVR at a tertiary hospital between 2018 and 2023, with pre-existing left ventricular dysfunction (LVEF < 50%). Baseline clinical characteristics and echocardiographic measurements were collected at the time of the procedure. Follow-up echo were performed to reassess LVEF. Univariate analysis, including chi-square and independent t-tests, as well as a logistic regression model, Kaplan-Meier survival curves and Cox proportional hazards regression were used. A p-value < 0.05 was considered statistically significant.
Results
A total of 97 patients were included in the analysis, to groups were formed based on LVEF<50% on midterm follow up. 36 (37,1%) pt had an LVEF < 50%. Patients who maintained rLVEF were significantly younger and male (mean age 77±8,4 Vs 82±5,5 years, p = 0,048; male sex 33 Vs 54%, p=0,048). There were no significant differences the 2 groups regarding comorbidities, and medication use. Additionally, patients with sustained reduced LVEF had a lower pre-TAVR LVEF (35,4 ±9,5% vs. 40,7 ±7,4%, p = 0,001) and mean aortic valve gradient (35,4 ±12mmHg vs. 45 ±13,4mmHg, p = 0,001). Logistic regression analysis identified age (OR = 0,882, 95% CI: 0.803 - 0.969, p = 0,009) and mean AV gradient (OR = 0,957, 95% CI: 0.917 - 0.999, p = 0,47) as independent factors associated with a lower likelihood of maintaining rLVEF. Kaplan-Meier survival analysis demonstrated that patients with sustained rLVEF had significantly higher all-cause mortality (HR 2,68 (1,052 - 6,811), p=0,039) and cardiovascular hospitalizations (HR 9,195 (2,037 - 18,843), p=0,001).
Conclusion
This study found that patients who maintained reduced LVEF post-TAVR had worse long-term outcomes, including higher all-cause mortality and cardiovascular hospitalizations. Younger age and a lower mean AV mean gradient were identified as factors linked to sustained rLVEF. These results highlight the importance of assessing pre-procedural characteristics to predict which patients are at risk for persistent reduced LVEF. Further research is needed to refine these predictors and improve post-procedural management strategies.