Impact of flow on outcomes in patients with left ventricular systolic dysfunction undergoing TAVR

TAVR is associated with better outcomes for patients with classical low-flow low-gradient aortic stenosis (C-LFLG AS) and normal-flow low-gradient (NFLG AS) compared to medical management. Left ventricular ejection fraction (LVEF) predicts mortality in patients undergoing TAVR. However, the outcomes based on flow in patients with lower LVEF undergoing TAVR remain unclear.

This study explored the outcomes of patients with reduced LVEF undergoing TAVR with C-LFLG AS and NFLG AS. It also explored the hemodynamic changes post-TAVR in these populations and identified factors determining their outcomes.

In this retrospective, single-center study involving 305 patients with severe AS, patients were classified into 2 groups: 1) C-LFLG AS, AV mean gradient (MG) <40 mmHg, stroke volume index (SVI) <35 mL/m², LVEF <50 %; 2) Low LVEF NFLG AS: MG <40 mmHg, SVI ≥35 mL/m², LVEF <50 %. Binary logistic regression was used to assess the determinants of C-LFLG AS and NFLG AS. Cox regression was used to determine the clinical outcomes.

Of 2600 patients undergoing TAVR, low LVEF patients meeting the inclusion criteria were 305. NFLG AS was less common (18 %). Patients in the C-LFLG AS had similar mortality (hazard ratio (HR) = 1.07, 95 % confidence interval (CI) 0.64-1.80), and heart failure rehospitalization (HR = 1.31, CI 0.69-2.48) rates 3 years post-TAVR, compared to patients with low LVEF NFLG AS. End-stage renal disease was associated with NFLG AS, whereas diabetes predicted C-LFLG AS.

Mortality after TAVR was similar in patients with low-gradient severe AS and LV systolic dysfunction regardless of flow.