title: Impact of left ventricular systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation for severe aortic stenosis.
abstract: BACKGROUND
  This study aimed to evaluate the impact of baseline left ventricular (LV) systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation (TAVI). Survival of patients undergoing TAVI was also compared with that of a population undergoing surgical aortic valve replacement.
  
  
  METHODS
  One hundred forty-seven consecutive patients (mean age=80±7 years) undergoing TAVI in 2 centers were included. Mean follow-up period was 9.1±5.1 months.
  
  
  RESULTS
  At baseline, 34% of patients had impaired LV ejection fraction (LVEF) (<50%) and 66% had normal LVEF (≥50%). Procedural success was similar in these 2 groups (94% vs 97%, P=.41). All patients achieved improvement in transvalvular hemodynamics. At follow-up, patients with a baseline LVEF<50% showed marked LV reverse remodeling, with improvement of LVEF (from 37%±8% to 51%±11%). Early and late mortality rates were not different between the 2 groups, despite a higher rate of combined major adverse cardiovascular events (MACEs) in patients with a baseline LVEF<50%. The predictors of cumulative MACEs were baseline LVEF (HR=0.97, 95% CI=0.94-0.99) and preoperative frailty (HR=4.20, 95% CI=2.00-8.84). In addition, long-term survival of patients with impaired or normal LVEF was comparable with that of a matched population who underwent surgical aortic valve replacement.
  
  
  CONCLUSIONS
  TAVI resulted in significant improvement in LV function and survival benefit in high-risk patients with severe aortic stenosis, regardless of baseline LVEF. Patients with a baseline LVEF<50% were at higher risk of combined MACEs.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: See Hooi
authors.initials: SH
authors.lastname: Ewe
authors.forename: Nina
authors.initials: N
authors.lastname: Ajmone Marsan
authors.forename: Mauro
authors.initials: M
authors.lastname: Pepi
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Gloria
authors.initials: G
authors.lastname: Tamborini
authors.forename: Manuela
authors.initials: M
authors.lastname: Muratori
authors.forename: Arnold C T
authors.initials: AC
authors.lastname: Ng
authors.forename: Frank
authors.initials: F
authors.lastname: van der Kley
authors.forename: Arend
authors.initials: A
authors.lastname: de Weger
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Melissa
authors.initials: M
authors.lastname: Fusari
authors.forename: Paolo
authors.initials: P
authors.lastname: Biglioli
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D013318:Stroke Volume; D013599:Systole; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*; D020257:Ventricular Remodeling