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Predictors and prognostic impact of early EF recovery in patients with AS and reduced EF after TAVI
Session:
Painel 3 - Imagiologia Cardiovascular 1
Speaker:
Cláudia Jesus Silva
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Cláudia Jesus Silva; Catarina Brízido; Marisa Trabulo; Pedro Freitas; João Brito; Regina Ribeiras; Manuel Canada; Maria João Andrade; Eduarda Horta; Carla Reis; Afonso Félix De Oliveira; Tiago Nolasco; Pedro de Araújo Gonçalves; Rui Campante Teles; Manuel Almeida; Miguel Mendes
Abstract
<p><strong>Introduction: </strong>Patients with severe aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF) have a dismal prognosis compared with patients with preserved LVEF. Transcatheter aortic valve implantation (TAVI) has evidenced favourable results in this setting. This study aims to determine predictors of early LV ejection fraction (LVEF) recovery after TAVI and its subsequent prognostic impact.</p> <p><strong>Methods</strong>: Prospective single-centre registry including 96 consecutive patients (mean age 81 ± 7 years, 43% female, median Euroscore II 5.3 % [IQR 3.6–8.0]) with severe AS and LV dysfunction (LVEF<50% assessed by biplane Simpson’s method) who underwent TAVI between Jan/2015 and Apr/2019. A retrospective analysis defined early LVEF improvement as an absolute increase in LVEF ≥10% at discharge, in comparison to baseline LVEF. Survival analysis (Cox-regression hazards model and Kaplan-Meier) was performed at a median follow-up of 20 months (IQR 13-28). Univariable and multivariable analysis were performed to determine independent predictors of lack in LVEF recovery.</p> <p><strong>Results</strong>: The median interval between TAVI and pre-discharge TTE was 4 days (IQR 2–5). Early LVEF recovery occurred in 43% (n=41) of the patients (R-group) and did not occurred in 57% (n=55; no-R group). Mean LVEF before TAVI was 40 ± 9% in the R-group and 37 ± 9% in the no-R group (p=0.083). The univariable analysis identified male sex, baseline indexed LV diastolic volume >75 ml/m<sup>2</sup>, relative wall thickness (RWT) <0.42, and systolic pulmonary artery pressure (SPAP) >50 mmHg associated with a reduced likelihood of LVEF improvement after TAVI. By multivariate analysis, indexed LV diastolic volume >75 ml/m<sup>2</sup> (HR 5.174, 95%CI 1.115-24.010; p=0.04) and RWT <0.42 (HR 3.754, 95%CI 1.00-14.083; p=0.05) were independent predictors of absent early LVEF recovery. A total of 23 deaths occurred – 8 on the R group and 14 on the no-R group (HR 0.30, 95%CI 0.30-1.74, log-rank p=0.47). </p> <p><strong>Conclusion</strong>: Augmented left ventricle volume independently predicted the lack of early recovery of LVEF after TAVI, suggesting that patients without LV dilatation, may not have intrinsic myocardial disease but just afterload mismatch which could explain the rapid improvement of LVEF. However, and given a possible lack of statistical power, LVEF recovery was not associated with improved survival in this cohort.</p>
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