Impact of Left Ventricular Ejection Fraction and its Improvement in Patients with Aortic Stenosis Following Transcatheter Aortic Valve Implantation

Abstract

Background: Previous studies have established low Left Ventricular Ejection Fraction (LVEF) as a significant predictor of poor prognosis across various cardiac conditions. However, the prognostic implications of low LVEF and its postoperative improvement in patients undergoing Transcatheter Aortic Valve Implantation (TAVI) remain unclear.

Methods and Results: We reviewed consecutive patients with severe aortic stenosis (AS) who underwent TAVI between January 2016 and October 2022. Patients were categorized into three groups based on LVEF: preserved LVEF (≥50%), mildly reduced LVEF (40-49%), and reduced LVEF (＜40%). The primary outcome was a composite of all-cause mortality and heart failure rehospitalization, with subgroup analysis on rapid LVEF improvement (≥10% increase at discharge). A total of 909 patients were included: 769 with preserved LVEF, 69 with mildly reduced LVEF, and 71 with reduced LVEF. Kaplan-Meier analysis showed that LVEF pattern significantly predicted composite outcomes (log-rank p＜0.001), with reduced LVEF indicating the poorest prognosis. Rapid LVEF improvement was observed in 39.7% of patients with reduced LVEF. Logistic regression identified low pressure gradient as independently associated with the absence of significant LVEF improvement post-TAVI.

Conclusion: Reduced LVEF is a predictor of poor prognosis in TAVI patients. Although LVEF can improve postoperatively, this improvement does not necessarily lead to better outcomes. Careful patient selection and consideration of myocardial fibrosis are essential in managing these patients.