Effect of Baseline Left Ventricular Ejection Fraction on 2-Year Outcomes After Transcatheter Aortic Valve Replacement-Reference-Cited by-同舟云学术

Effect of Baseline Left Ventricular Ejection Fraction on 2-Year Outcomes After Transcatheter Aortic Valve Replacement

Published:2019-08 Issue:8 Volume:12 Page:
ISSN:1941-3289
Container-title:Circulation: Heart Failure
language:en
Short-container-title:Circ: Heart Failure

Author:

Furer Ariel¹²³,Chen Shmuel¹,Redfors Bjorn¹⁴,Elmariah Sammy⁵,Pibarot Philippe⁶,Herrmann Howard C.⁷,Hahn Rebecca T.⁸,Kodali Susheel⁸,Thourani Vinod H.⁹,Douglas Pamela S.¹⁰,Alu Maria C.¹⁸,Fearon William F.¹¹,Passeri Jonathan⁵,Malaisrie S. Chris¹²,Crowley Aaron¹,McAndrew Thomas¹,Genereux Philippe¹³,Ben-Yehuda Ori¹,Leon Martin B.¹⁸,Burkhoff Daniel¹⁸

Affiliation:

1. Cardiovascular Research Foundation, New York, NY (A.F., S.C., B.R., M.C.A., A.C., T.M., O.B.-Y., M.B.L., D.B.).

2. IDF Medical Corps Headquarters, Israel (A.F.).

3. School of Military Medicine, Hadassah Medical Center, Jerusalem, Israel (A.F.).

4. Sahlgrenska University Hospital, Göteborg, Sweden (B.R.).

5. Department of Cardiology, Massachusetts General Hospital, Boston (S.E., J.P.).

6. Department of Medicine, Quebec Heart & Lung Institute Laval University, Canada (P.P.).

7. Department of Medicine, University of Pennsylvania, Philadelphia (H.C.H.).

8. Department of Medicine, Columbia University Medical Center, New York, NY (R.T.H., S.K., M.C.A., M.B.L., D.B.).

9. MedStar Heart & Vascular Institute, Georgetown University School of Medicine, Washington, DC (V.H.T.).

10. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.).

11. Department of Medicine (Cardiovascular Medicine), Stanford University, CA (W.F.F.).

12. Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.C.M.).

13. Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.).

Abstract

Background: Impaired left ventricular function is associated with worse prognosis among patients with aortic stenosis treated medically or with surgical aortic valve replacement. It is unclear whether reduced left ventricular ejection fraction (LVEF) is an independent predictor of adverse outcomes after transcatheter aortic valve replacement. Methods and Results: Patients who underwent transcatheter aortic valve replacement in the PARTNER 2 trials (Placement of Aortic Transcatheter Valves) and registries were stratified according to presence of reduced LVEF (<50%) at baseline, and 2-year risk of cardiovascular mortality was compared using Kaplan–Meier methods and multivariable Cox proportional hazards regression. Of 2991 patients, 839 (28%) had reduced LVEF. These patients were younger, more often males, and were more likely to have comorbidities, such as coronary disease, diabetes mellitus, and renal insufficiency. Compared with patients with normal LVEF, patients with low LVEF had higher crude rates of 2-year cardiovascular mortality (19.8% versus 12.0%, P <0.0001) and all-cause mortality (27.4% versus 19.2%, P <0.0001). Mean aortic valve gradient was not associated with clinical outcomes other than heart failure hospitalizations (hazard ratio [HR], 0.99; CI, 0.99–1.00; P =0.03). After multivariable adjustment, patients with reduced versus normal LVEF had significantly higher adjusted risk of cardiovascular death (adjusted HR, 1.42, 95% CI, 1.11–1.81; P =0.005), but not all-cause death (adjusted HR, 1.20; 95% CI, 0.99–1.47; P =0.07). When LVEF was treated as continuous variable, it was associated with increased 2-year risk of both cardiovascular mortality (adjusted HR per 10% decrease in LVEF, 1.16; 95% CI, 1.07–1.27; P =0.0006) and all-cause mortality (adjusted HR, 1.09; 95% CI, 1.01–1.16; P =0.02). Conclusions: In this patient-level pooled analysis of PARTNER 2 patients who underwent transcatheter aortic valve replacement, baseline LVEF was an independent predictor of 2-year cardiovascular mortality. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01314313, NCT02184442, NCT03222128, and NCT02184441.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

Reference36 articles.

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4. Aortic valve replacement in severe aortic stenosis with left ventricular dysfunction: determinants of cardiac mortality and ventricular function recovery

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