In patients wit
h aortic stenosis undergoing transcat
heter aortic valve replacement (TAVR), studies
have suggested t
hat reduced left ventricular (LV) ejection fraction (LVEF) and low aortic valve gradient (AVG) are associated wit
h worse long-term outcomes. Because t
hese conditions commonly coexist, t
he extent to w
hic
h t
hey are independently associated wit
h outcomes after TAVR is unknown.<
h4 id="absSec_2">Objectives
h4>
The purpose of this study was to evaluate the impact of LVEF and AVG on clinical outcomes after TAVR and to determine whether the effect of AVG on outcomes is modified by LVEF.
<
h4 id="absSec_3">Met
hods
h4>
Using data from 11,292 patients who underwent TAVR as part of the Transcatheter Valve Therapies Registry, we examined rates of 1-year mortality and recurrent heart failure in patients with varying levels of LV dysfunction (LVEF <30% vs. 30% to 50% vs. >50%) and AVG (<40 mm Hg vs. ≥40 mm Hg). Multivariable models were used to estimate the independent effect of AVG and LVEF on outcomes.
<
h4 id="absSec_4">Results
h4>
During the first year of follow-up after TAVR, patients with LV dysfunction and low AVG had higher rates of death and recurrent heart failure. After adjustment for other clinical factors, only low AVG was associated with higher mortality (hazard ratio: 1.21; 95% confidence interval: 1.11 to 1.32; p < 0.001) and higher rates of heart failure (hazard ratio: 1.52; 95% confidence interval: 1.36 to 1.69; p <0.001), whereas the effect of LVEF was no longer significant. There was no evidence of effect modification between AVG and LVEF with respect to either endpoint.
<
h4 id="absSec_5">Conclusions
h4>
In this series of real-world patients undergoing TAVR, low AVG, but not LV dysfunction, was associated with higher rates of mortality and recurrent heart failure. Although these findings suggest that AVG should be considered when evaluating the risks and benefits of TAVR for individual patients, neither severe LV dysfunction nor low AVG alone or in combination provide sufficient prognostic discrimination to preclude treatment with TAVR.