title: Impact of coronary artery disease on left ventricular ejection fraction recovery following transcatheter aortic valve implantation.
abstract: OBJECTIVE
  The objective of the present study was to assess if the presence and severity of CAD is associated with decreased LVEF recovery after TAVI.
  
  
  BACKGROUND
  Coronary artery disease (CAD) and low left ventricular ejection fraction (LVEF) are common findings in patients undergoing transcatheter aortic valve implantation (TAVI). The impact of CAD on LVEF recovery after TAVI has not been specifically evaluated.
  
  
  METHODS
  All patients with LVEF≤50% who underwent TAVI between March 2006 and May 2012 were included in the study. The presence and severity of coronary artery disease was measured using the Duke Myocardial Jeopardy Score (DMJS). A DMJS = 0 corresponds to patients without CAD or complete revascularization and a DMJS > 0 to those with incomplete revascularization. LVEF recovery was assessed by transthoracic echocardiography, measuring the change in LVEF from baseline to 3-months post-TAVI. Myocardial viability was evaluated in a subgroup of patients using cardiac magnetic resonance (CMR) imaging pre-TAVI.
  
  
  RESULTS
  Fifty-six patients were included in the study. Twenty-eight patients (50%) had a DMJS > 0. At 3 months, patients with incomplete revascularization (DMJS > 0) demonstrated less LVEF recovery post-TAVI (2.0 ± 9.2% versus 11.7 ± 8.9% if DMJS = 0; P = 0.001). On multivariate analysis, DMJS and presence of significant delayed-enhancement were found to be independent predictors of LVEF recovery. Patients with incomplete revascularization exhibited a worse prognosis with higher mortality at 30-days (22.2% versus 0% if DMJS = 0; P = 0.010) and 1-year (25.9% versus 3.5% if DMJS = 0; P = 0.019).
  
  
  CONCLUSIONS
  The present study demonstrates an independent association between incomplete revascularization and decreased LVEF recovery in patients with left ventricular dysfunction undergoing TAVI for severe aortic stenosis.
authors.affiliation: Division of Cardiology and Cardiovascular Surgery, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Xavier
authors.initials: X
authors.lastname: Freixa
authors.forename: Jason
authors.initials: J
authors.lastname: Chan
authors.forename: Raoul
authors.initials: R
authors.lastname: Bonan
authors.forename: Ragui
authors.initials: R
authors.lastname: Ibrahim
authors.forename: Yoan
authors.initials: Y
authors.lastname: Lamarche
authors.forename: Philippe
authors.initials: P
authors.lastname: Demers
authors.forename: Arsène
authors.initials: A
authors.lastname: Basmadjian
authors.forename: Réda
authors.initials: R
authors.lastname: Ibrahim
authors.forename: Raymond
authors.initials: R
authors.lastname: Cartier
authors.forename: Anita W
authors.initials: AW
authors.lastname: Asgar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: TAVI; aortic stenosis; coronary artery disease; ejection fraction; recovery; ventricular function