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Impact of Ejection Fraction and Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Replacement.

Publication ,  Journal Article
Baron, SJ; Arnold, SV; Herrmann, HC; Holmes, DR; Szeto, WY; Allen, KB; Chhatriwalla, AK; Vemulapali, S; O'Brien, S; Dai, D; Cohen, DJ
Published in: J Am Coll Cardiol
May 24, 2016

BACKGROUND: In patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), studies have suggested that reduced left ventricular (LV) ejection fraction (LVEF) and low aortic valve gradient (AVG) are associated with worse long-term outcomes. Because these conditions commonly coexist, the extent to which they are independently associated with outcomes after TAVR is unknown. OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 24, 2016

Volume

67

Issue

20

Start / End Page

2349 / 2358

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • United States
  • Transcatheter Aortic Valve Replacement
  • Stroke Volume
  • Registries
  • Recurrence
  • Male
  • Humans
  • Heart Failure
  • Follow-Up Studies
 

Citation

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Baron, S. J., Arnold, S. V., Herrmann, H. C., Holmes, D. R., Szeto, W. Y., Allen, K. B., … Cohen, D. J. (2016). Impact of Ejection Fraction and Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol, 67(20), 2349–2358. https://doi.org/10.1016/j.jacc.2016.03.514
Baron, Suzanne J., Suzanne V. Arnold, Howard C. Herrmann, David R. Holmes, Wilson Y. Szeto, Keith B. Allen, Adnan K. Chhatriwalla, et al. “Impact of Ejection Fraction and Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Replacement.J Am Coll Cardiol 67, no. 20 (May 24, 2016): 2349–58. https://doi.org/10.1016/j.jacc.2016.03.514.
Baron SJ, Arnold SV, Herrmann HC, Holmes DR, Szeto WY, Allen KB, et al. Impact of Ejection Fraction and Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2016 May 24;67(20):2349–58.
Baron, Suzanne J., et al. “Impact of Ejection Fraction and Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Replacement.J Am Coll Cardiol, vol. 67, no. 20, May 2016, pp. 2349–58. Pubmed, doi:10.1016/j.jacc.2016.03.514.
Baron SJ, Arnold SV, Herrmann HC, Holmes DR, Szeto WY, Allen KB, Chhatriwalla AK, Vemulapali S, O’Brien S, Dai D, Cohen DJ. Impact of Ejection Fraction and Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2016 May 24;67(20):2349–2358.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

May 24, 2016

Volume

67

Issue

20

Start / End Page

2349 / 2358

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • United States
  • Transcatheter Aortic Valve Replacement
  • Stroke Volume
  • Registries
  • Recurrence
  • Male
  • Humans
  • Heart Failure
  • Follow-Up Studies