Heart failure in severe aortic valve stenosis: prognostic impact of left ventricular ejection fraction and mean gradient on outcome after transcatheter aortic valve implantation.
OBJECTIVE
This prospective study aimed to evaluate the prognostic impact of left ventricular ejection fraction (LVEF) and aortic mean gradient patterns on outcome after transcatheter aortic valve implantation (TAVI).


RESULTS
From 2008 to 2011, 202 consecutive patients with severe symptomatic aortic valve stenosis (aortic valve area <1.0 cm(2)) were submitted to TAVI. Patients were divided into four groups according to LVEF (>50% vs. ≤ 50%) and aortic mean pressure gradient (>40 mmHg vs. ≤ 40 mmHg): group 1, preserved LVEF/high gradient (n = 86); group 2, preserved LVEF/low gradient (n = 27); group 3, reduced LVEF/high gradient (n = 45); and group 4, reduced LVEF/low gradient (n = 44). A CoreValve prosthesis (Medtronic, Minneapolis, MN, USA) was inserted retrogradely. Echocardiography was performed before and 1 year after TAVI. The primary study endpoint (1-year all-cause mortality) was reached in 47 patients (23%). All-cause mortality was lowest in group 1 (14%), intermediate in group 2 (22%) and group 3 (27%), and highest in group 4 (39%) (P = 0.007). In survivors, aortic mean gradient decreased in all patients (baseline 48 ± 13 mmHg vs. 10 ± 4 mmHg at 1 year, P < 0.001). LVEF improved in group 3 and group 4 (baseline 42 ± 8% vs. 51 ± 11% at 1 year, P < 0.001).


CONCLUSIONS
Severe aortic stenosis with low gradient and/or reduced LVEF is associated with worse outcome after TAVI compared with aortic stenosis with preserved LVEF/high gradient. The evaluation of these haemodynamic parameters may help to improve risk stratification in patients undergoing TAVI.
Berufsgenossenschaftliche Kliniken Bergmannsheil, Cardiology and Angiology, Ruhr-University Bochum, D-44789 Bochum, Germany. michael_gotzmann@web.de
Michael
M
Gotzmann
Pia
P
Rahlmann
Tobias
T
Hehnen
Patrick
P
Müller
Michael
M
Lindstaedt
Andreas
A
Mügge
Aydan
A
Ewers
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D006328:Cardiac Catheterization; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000601:surgery*; D016277:Ventricular Function, Left