Significant improvement in early LVEF and 5-yr mortality rate post TAVR: JAMA

Significant improvement in left ventricular ejection fraction (LVEF) and lower 5-year all-cause mortality can be seen within 1 month after transcatheter aortic valve replacement (TAVR) in patients with severe aortic stenosis and LVEF less than 50% as per a recent study that was published in the journal "JAMA Cardiology." 

Previous research indicates that in patients with severe aortic stenosis and left ventricular ejection fraction of less than 50%, early LVEF improvement after TAVR is associated with improved 1-year mortality. So, researchers conducted a study to examine the association between early LVEF improvement after TAVR and 5-year outcomes. 

Researchers performed a cohort study to analyze patients enrolled in the Placement of Aortic Transcatheter Valves (PARTNER) 1, 2, and S3 trials and registries between July 2007 and April 2015. High- and intermediate-risk patients with a baseline LVEF of less than 50% who underwent transfemoral TAVR were included in the study. Data were analyzed from August 2020 to May 2021. Early LVEF improvement, defined as an increase of 10 percentage points or more at 30 days and also as a continuous variable (ΔLVEF between baseline and 30 days) along with All-cause death at 5 years were the main outcomes of measurement. 

Results: 

• 659 patients were taken into the study with LVEF of less than 50%. Of these 468 (71.0%) were male, and the mean (SD) age was 82.4 (7.7) years.
• LVEF improvement within 30 days following transfemoral TAVR occurred in 216 patients (32.8%).
• Prior myocardial infarction, diabetes, cancer, higher baseline LVEF, larger left ventricular end-diastolic diameter, and larger aortic valve area was independently associated with a lower likelihood of LVEF improvement.
• Patients with vs without early LVEF improvement after TAVR had lower 5-year all-cause death and cardiac death.
• In multivariable analyses, early improvement in LVEF (modeled as a continuous variable) was associated with lower 5-year all-cause death and cardiac death after TAVR.
• Restricted cubic spline analysis demonstrated a visual inflection point at ΔLVEF of 10% beyond which there was a steep decline in all-cause mortality with an increasing degree of LVEF improvement.
• There were no statistically significant differences in rehospitalization, New York Heart Association functional class, or Kansas City Cardiomyopathy Questionnaire Overall Summary score at 5 years in patients with vs without early LVEF improvement.
• In subgroup analysis, the association between early LVEF improvement and 5-year all-cause death was consistent regardless of the presence or absence of coronary artery disease or prior myocardial infarction. 

Thus, the researchers concluded that 1 in 3 patients with severe aortic stenosis and LVEF less than 50% experienced LVEF improvement within 1 month after TAVR and is also associated with lower 5-year all-cause and cardiac death. 

To read the full article, click here: doi:10.1001/jamacardio.2022.2222 

Kolte D, Bhardwaj B, Lu M, et al. Association Between Early Left Ventricular Ejection Fraction Improvement After Transcatheter Aortic Valve Replacement and 5-Year Clinical Outcomes. JAMA Cardiol. Published online July 27, 2022. doi:10.1001/jamacardio.2022.2222