Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation

Guy Witberg; Amos Levi; Yeela Talmor-Barkan; Marco Barbanti; Roberto Valvo; Giuliano Costa; Valentina Frittitta; Ole De Backer; Yannick Willemen; Mark van Der Dorpel; Matias Mon; Atsushi Sugiura; Mitsumasa Sudo; Giulia Masiero; Edoardo Pancaldi; Dabit Arzamendi; Sandra Santos-Martinez; Jose A. Baz; Klemen Steblovnik; Victor Mauri; Matti Adam; Hendrik Wienemann; David Zahler; Manuel Hein; Philipp Ruile; Brídóg Nic Aodha; Carmelo Grasso; Luca Branca; Rodrigo Estévez-Loureiro; Ignacio J. Amat-Santos; Darren Mylotte; Matjaz Bunc; Giuseppe Tarantini; Luis Nombela-Franco; Lars Sondergaard; Nicolas M. Van Mieghem; Ariel Finkelstein; Ran Kornowski

doi:10.4244/EIJ-D-23-00948

Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation

Guy Witberg, Amos Levi, Yeela Talmor-Barkan, Marco Barbanti, Roberto Valvo, Giuliano Costa, Valentina Frittitta, Ole De Backer, Yannick Willemen, Mark van Der Dorpel, Matias Mon, Atsushi Sugiura, Mitsumasa Sudo, Giulia Masiero, Edoardo Pancaldi, Dabit Arzamendi, Sandra Santos-Martinez, Jose A. Baz, Klemen Steblovnik, Victor MauriMatti Adam, Hendrik Wienemann, David Zahler, Manuel Hein, Philipp Ruile, Brídóg Nic Aodha, Carmelo Grasso, Luca Branca, Rodrigo Estévez-Loureiro, Ignacio J. Amat-Santos, Darren Mylotte, Matjaz Bunc, Giuseppe Tarantini, Luis Nombela-Franco, Lars Sondergaard, Nicolas M. Van Mieghem, Ariel Finkelstein, Ran Kornowski

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

BACKGROUND: Data on the likelihood of left ventricle (LV) recovery in patients with severe LV dysfunction and severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and its prognostic value are limited. AIMS: We aimed to assess the likelihood of LV recovery following TAVI, examine its association with midterm mortality, and identify independent predictors of LV function. METHODS: In our multicentre registry of 17 TAVI centres in Western Europe and Israel, patients were stratified by baseline LV function (ejection fraction [EF] >/≤30%) and LV response: no LV recovery, LV recovery (EF increase ≥10%), and LV normalisation (EF ≥50% post-TAVI). RESULTS: Our analysis included 10,872 patients; baseline EF was ≤30% in 914 (8.4%) patients and >30% in 9,958 (91.6%) patients. The LV recovered in 544 (59.5%) patients, including 244 (26.7%) patients whose LV function normalised completely (EF >50%). Three-year mortality for patients without severe LV dysfunction at baseline was 29.4%. Compared to this, no LV recovery was associated with a significant increase in mortality (adjusted hazard ratio 1.32; p<0.001). Patients with similar LV function post-TAVI had similar rates of 3-year mortality, regardless of their baseline LV function. Three variables were associated with a higher likelihood of LV recovery following TAVI: no previous myocardial infarction (MI), estimated glomerular filtration rate >60 mL/min, and mean aortic valve gradient (mAVG) (expressed either as a continuous variable or as a binary variable using the standard low-flow, low-gradient aortic stenosis [AS] definition). CONCLUSIONS: LV recovery following TAVI and the extent of this recovery are major determinants of midterm mortality in patients with severe AS and severe LV dysfunction undergoing TAVI. Patients with no previous MI and those with an mAVG >40 mmHg show the best results following TAVI, which are at least equivalent to those for patients without severe LV dysfunction.

Original language	English
Pages (from-to)	E487-E495
Journal	EuroIntervention
Volume	20
Issue number	8
DOIs	https://doi.org/10.4244/EIJ-D-23-00948
Publication status	Published - Apr 2024
Externally published	Yes

Keywords

aortic stenosis
depressed left ventricular function
TAVI

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10.4244/EIJ-D-23-00948

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Witberg, G., Levi, A., Talmor-Barkan, Y., Barbanti, M., Valvo, R., Costa, G., Frittitta, V., De Backer, O., Willemen, Y., van Der Dorpel, M., Mon, M., Sugiura, A., Sudo, M., Masiero, G., Pancaldi, E., Arzamendi, D., Santos-Martinez, S., Baz, J. A., Steblovnik, K., ... Kornowski, R. (2024). Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation. EuroIntervention, 20(8), E487-E495. https://doi.org/10.4244/EIJ-D-23-00948

@article{f77934ceb4ba43b3939fabf100d3633a,

title = "Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation",

abstract = "BACKGROUND: Data on the likelihood of left ventricle (LV) recovery in patients with severe LV dysfunction and severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and its prognostic value are limited. AIMS: We aimed to assess the likelihood of LV recovery following TAVI, examine its association with midterm mortality, and identify independent predictors of LV function. METHODS: In our multicentre registry of 17 TAVI centres in Western Europe and Israel, patients were stratified by baseline LV function (ejection fraction [EF] >/≤30%) and LV response: no LV recovery, LV recovery (EF increase ≥10%), and LV normalisation (EF ≥50% post-TAVI). RESULTS: Our analysis included 10,872 patients; baseline EF was ≤30% in 914 (8.4%) patients and >30% in 9,958 (91.6%) patients. The LV recovered in 544 (59.5%) patients, including 244 (26.7%) patients whose LV function normalised completely (EF >50%). Three-year mortality for patients without severe LV dysfunction at baseline was 29.4%. Compared to this, no LV recovery was associated with a significant increase in mortality (adjusted hazard ratio 1.32; p<0.001). Patients with similar LV function post-TAVI had similar rates of 3-year mortality, regardless of their baseline LV function. Three variables were associated with a higher likelihood of LV recovery following TAVI: no previous myocardial infarction (MI), estimated glomerular filtration rate >60 mL/min, and mean aortic valve gradient (mAVG) (expressed either as a continuous variable or as a binary variable using the standard low-flow, low-gradient aortic stenosis [AS] definition). CONCLUSIONS: LV recovery following TAVI and the extent of this recovery are major determinants of midterm mortality in patients with severe AS and severe LV dysfunction undergoing TAVI. Patients with no previous MI and those with an mAVG >40 mmHg show the best results following TAVI, which are at least equivalent to those for patients without severe LV dysfunction.",

keywords = "aortic stenosis, depressed left ventricular function, TAVI",

author = "Guy Witberg and Amos Levi and Yeela Talmor-Barkan and Marco Barbanti and Roberto Valvo and Giuliano Costa and Valentina Frittitta and {De Backer}, Ole and Yannick Willemen and {van Der Dorpel}, Mark and Matias Mon and Atsushi Sugiura and Mitsumasa Sudo and Giulia Masiero and Edoardo Pancaldi and Dabit Arzamendi and Sandra Santos-Martinez and Baz, {Jose A.} and Klemen Steblovnik and Victor Mauri and Matti Adam and Hendrik Wienemann and David Zahler and Manuel Hein and Philipp Ruile and Aodha, {Br{\'i}d{\'o}g Nic} and Carmelo Grasso and Luca Branca and Rodrigo Est{\'e}vez-Loureiro and Amat-Santos, {Ignacio J.} and Darren Mylotte and Matjaz Bunc and Giuseppe Tarantini and Luis Nombela-Franco and Lars Sondergaard and {Van Mieghem}, {Nicolas M.} and Ariel Finkelstein and Ran Kornowski",

year = "2024",

month = apr,

doi = "10.4244/EIJ-D-23-00948",

language = "English",

volume = "20",

pages = "E487--E495",

journal = "EuroIntervention",

issn = "1774-024X",

publisher = "Europa Group",

number = "8",

}

Witberg, G, Levi, A, Talmor-Barkan, Y, Barbanti, M, Valvo, R, Costa, G, Frittitta, V, De Backer, O, Willemen, Y, van Der Dorpel, M, Mon, M, Sugiura, A, Sudo, M, Masiero, G, Pancaldi, E, Arzamendi, D, Santos-Martinez, S, Baz, JA, Steblovnik, K, Mauri, V, Adam, M, Wienemann, H, Zahler, D, Hein, M, Ruile, P, Aodha, BN, Grasso, C, Branca, L, Estévez-Loureiro, R, Amat-Santos, IJ, Mylotte, D, Bunc, M, Tarantini, G, Nombela-Franco, L, Sondergaard, L, Van Mieghem, NM, Finkelstein, A & Kornowski, R 2024, 'Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation', EuroIntervention, vol. 20, no. 8, pp. E487-E495. https://doi.org/10.4244/EIJ-D-23-00948

TY - JOUR

T1 - Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation

AU - Witberg, Guy

AU - Levi, Amos

AU - Talmor-Barkan, Yeela

AU - Barbanti, Marco

AU - Valvo, Roberto

AU - Costa, Giuliano

AU - Frittitta, Valentina

AU - De Backer, Ole

AU - Willemen, Yannick

AU - van Der Dorpel, Mark

AU - Mon, Matias

AU - Sugiura, Atsushi

AU - Sudo, Mitsumasa

AU - Masiero, Giulia

AU - Pancaldi, Edoardo

AU - Arzamendi, Dabit

AU - Santos-Martinez, Sandra

AU - Baz, Jose A.

AU - Steblovnik, Klemen

AU - Mauri, Victor

AU - Adam, Matti

AU - Wienemann, Hendrik

AU - Zahler, David

AU - Hein, Manuel

AU - Ruile, Philipp

AU - Aodha, Brídóg Nic

AU - Grasso, Carmelo

AU - Branca, Luca

AU - Estévez-Loureiro, Rodrigo

AU - Amat-Santos, Ignacio J.

AU - Mylotte, Darren

AU - Bunc, Matjaz

AU - Tarantini, Giuseppe

AU - Nombela-Franco, Luis

AU - Sondergaard, Lars

AU - Van Mieghem, Nicolas M.

AU - Finkelstein, Ariel

AU - Kornowski, Ran

PY - 2024/4

Y1 - 2024/4

N2 - BACKGROUND: Data on the likelihood of left ventricle (LV) recovery in patients with severe LV dysfunction and severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and its prognostic value are limited. AIMS: We aimed to assess the likelihood of LV recovery following TAVI, examine its association with midterm mortality, and identify independent predictors of LV function. METHODS: In our multicentre registry of 17 TAVI centres in Western Europe and Israel, patients were stratified by baseline LV function (ejection fraction [EF] >/≤30%) and LV response: no LV recovery, LV recovery (EF increase ≥10%), and LV normalisation (EF ≥50% post-TAVI). RESULTS: Our analysis included 10,872 patients; baseline EF was ≤30% in 914 (8.4%) patients and >30% in 9,958 (91.6%) patients. The LV recovered in 544 (59.5%) patients, including 244 (26.7%) patients whose LV function normalised completely (EF >50%). Three-year mortality for patients without severe LV dysfunction at baseline was 29.4%. Compared to this, no LV recovery was associated with a significant increase in mortality (adjusted hazard ratio 1.32; p<0.001). Patients with similar LV function post-TAVI had similar rates of 3-year mortality, regardless of their baseline LV function. Three variables were associated with a higher likelihood of LV recovery following TAVI: no previous myocardial infarction (MI), estimated glomerular filtration rate >60 mL/min, and mean aortic valve gradient (mAVG) (expressed either as a continuous variable or as a binary variable using the standard low-flow, low-gradient aortic stenosis [AS] definition). CONCLUSIONS: LV recovery following TAVI and the extent of this recovery are major determinants of midterm mortality in patients with severe AS and severe LV dysfunction undergoing TAVI. Patients with no previous MI and those with an mAVG >40 mmHg show the best results following TAVI, which are at least equivalent to those for patients without severe LV dysfunction.

AB - BACKGROUND: Data on the likelihood of left ventricle (LV) recovery in patients with severe LV dysfunction and severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and its prognostic value are limited. AIMS: We aimed to assess the likelihood of LV recovery following TAVI, examine its association with midterm mortality, and identify independent predictors of LV function. METHODS: In our multicentre registry of 17 TAVI centres in Western Europe and Israel, patients were stratified by baseline LV function (ejection fraction [EF] >/≤30%) and LV response: no LV recovery, LV recovery (EF increase ≥10%), and LV normalisation (EF ≥50% post-TAVI). RESULTS: Our analysis included 10,872 patients; baseline EF was ≤30% in 914 (8.4%) patients and >30% in 9,958 (91.6%) patients. The LV recovered in 544 (59.5%) patients, including 244 (26.7%) patients whose LV function normalised completely (EF >50%). Three-year mortality for patients without severe LV dysfunction at baseline was 29.4%. Compared to this, no LV recovery was associated with a significant increase in mortality (adjusted hazard ratio 1.32; p<0.001). Patients with similar LV function post-TAVI had similar rates of 3-year mortality, regardless of their baseline LV function. Three variables were associated with a higher likelihood of LV recovery following TAVI: no previous myocardial infarction (MI), estimated glomerular filtration rate >60 mL/min, and mean aortic valve gradient (mAVG) (expressed either as a continuous variable or as a binary variable using the standard low-flow, low-gradient aortic stenosis [AS] definition). CONCLUSIONS: LV recovery following TAVI and the extent of this recovery are major determinants of midterm mortality in patients with severe AS and severe LV dysfunction undergoing TAVI. Patients with no previous MI and those with an mAVG >40 mmHg show the best results following TAVI, which are at least equivalent to those for patients without severe LV dysfunction.

KW - aortic stenosis

KW - depressed left ventricular function

KW - TAVI

UR - http://www.scopus.com/inward/record.url?scp=85190903657&partnerID=8YFLogxK

U2 - 10.4244/EIJ-D-23-00948

DO - 10.4244/EIJ-D-23-00948

M3 - Article

C2 - 38629416

AN - SCOPUS:85190903657

SN - 1774-024X

VL - 20

SP - E487-E495

JO - EuroIntervention

JF - EuroIntervention

IS - 8

ER -

Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation

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Keywords

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