Impact of Supranormal LVEF After TAVI: Behavior, Mortality, and Cardiac Structure

Background/Objectives: Left ventricular ejection fraction (LVEF) typically improves after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (SAS). However, the clinical significance and prognosis of patients presenting with supranormal LVEF (≥65%) remain poorly defined. This study aims to describe LVEF behavior, its relationship with mortality, and its effect on cardiac structure in this specific subgroup. Methods: A retrospective observational study was conducted at Hospital Clínico San Carlos (2008-2019), including SAS patients with pre-procedural supranormal LVEF. Patients were classified into two groups: those whose LVEF normalized (55-65%) and those whose LVEF remained supranormal. Demographic, clinical, and echocardiographic variables were collected at baseline and one-year follow-up. The primary endpoint was all-cause mortality at two years. Results: Out of 101 analyzed patients (mean age 82.8 years, 71.2% women), 71 (70.3%) experienced LVEF normalization at one year. Two-year mortality was 10% in the normalized group and 9.8% in the non-variable group, showing no significant difference. Regarding geometric characteristics, a trend toward left ventricular mass regression was observed only in the LVEF-normalized group (Delta -10; p = 0.062 vs. -8.4; p = 0.197). History of bleeding was the only variable showing a trend toward worse prognosis (p = 0.064). Conclusions: LVEF behavior one year after TAVI in patients with baseline supranormal function tends toward normalization. This change is not associated with differences in two-year mortality but is linked to a trend toward beneficial reverse cardiac remodeling.