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Early Recovery of Left Ventricular Systolic Function After CoreValve Transcatheter Aortic Valve Replacement

Harold L Dauerman1, Michael J Reardon2, Jeffrey J Popma2

  • 1From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.). harold.dauerman@uvmhealth.org.

Circulation. Cardiovascular Interventions
|June 15, 2016
PubMed

Insights

Transcatheter aortic valve replacement significantly improves left ventricular ejection fraction (LVEF) in many patients with reduced LVEF. Early LVEF recovery after TAVR is linked to better outcomes and is predicted by higher valve gradients and no prior heart attack.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Reduced left ventricular ejection fraction (LVEF) affects approximately one-third of patients with symptomatic aortic stenosis awaiting transcatheter aortic valve replacement (TAVR).
  • The early recovery of LVEF after TAVR, its predictors, and clinical significance remain underexplored.

Purpose of the Study:

  • To investigate the incidence and predictors of early LVEF recovery following CoreValve TAVR in patients with pre-existing reduced LVEF.
  • To assess the association between early LVEF recovery and one-year clinical outcomes.

Main Methods:

  • Analysis of 156 patients from the CoreValve Extreme and High-Risk trials with baseline LVEF ≤40% and available 30-day LVEF data.
  • Echocardiographic assessment of LVEF at multiple time points (baseline, post-procedure, discharge, 30 days, 6 months, 1 year).
  • Definition of early LVEF recovery as an absolute increase of ≥10% in EF at 30 days; multivariable analysis for predictor identification.

Main Results:

  • Early LVEF recovery was observed in 62% of patients, often occurring before hospital discharge.
  • The early recovery group showed a significant LVEF increase (>17%) by 30 days compared to the no-early recovery group (48.9±8.8% vs. 31.5±6.9%).
  • Absence of previous myocardial infarction and a baseline mean aortic valve gradient ≥40 mmHg were identified as independent predictors of early LVEF recovery.

Conclusions:

  • Nearly two-thirds of patients with reduced LVEF experience significant early improvement after TAVR.
  • Early LVEF recovery post-TAVR is associated with improved clinical outcomes.
  • Higher baseline aortic valve gradients and the absence of prior myocardial infarction are key predictors for early LVEF recovery.
Abstract

Keywords:
aortic valve stenosismyocardial infarctionstroke volumetranscatheter aortic valve replacementventricular function, left

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