Association of Early Left Ventricular Ejection Fraction Patterns With Functional Recovery and Outcomes After...

Early changes in left ventricular ejection fraction (LVEF) after transcatheter aortic valve replacement (TAVR) in patients with pure aortic regurgitation (AR) may signal functional recovery potential and prognostic relevance, yet systematic evidence is lacking.

We retrospectively analyzed 128 consecutive patients with pure AR who underwent TAVR between 2018 and 2023 and experienced an acute postprocedural LVEF reduction (≥5%). LVEF was assessed using the Simpson's biplane method at discharge and at 1 month. Patients were categorized according to a 1-month LVEF change into Rebound pattern (≥10% increase) or Decliner pattern (<10% increase). The primary endpoint was major adverse cardiovascular events (MACE); secondary endpoints included 1-year LVEF normalization, cardiovascular mortality, and all-cause mortality. Group comparisons employed standard parametric or nonparametric tests. Predictors of 1-year LVEF normalization were assessed with multivariable logistic regression, while Kaplan-Meier and Cox models were used for time-to-event outcomes.

A Rebound pattern was observed in 54.69% of patients and was strongly associated with LVEF normalization at 1 year (odds ratio, 1.88; 95% CI, 1.57-1.96). Over a median follow-up of 945 days (interquartile range, 514-1319), the Rebound group experienced significantly fewer MACE (log-rank p = 0.043) and remained an independent protective factor for MACE, cardiovascular mortality, and all-cause mortality in multivariable analyses.

In patients with pure AR and acute LVEF decline after TAVR, early postoperative LVEF trajectory within 1 month independently predicts long-term functional recovery and prognosis. Routine assessment of early LVEF patterns may enhance risk stratification and inform individualized post-TAVR management.