TY - JOUR
T1 - Impact of severe left ventricular dysfunction on mid-term mortality in elderly patients undergoing transcatheter aortic valve implantation
AU - Ferrante, Giuseppe
AU - Presbitero, Patrizia
AU - Pagnotta, Paolo Antonio
AU - Petronio, A. Sonia
AU - Brambilla, Nedy
AU - De Marco, Federico
AU - Fiorina, Claudia
AU - Giannini, Cristina
AU - D'Ascenzo, Fabrizio
AU - Klugmann, Silvio
AU - Rossi, Marco Luciano
AU - Ettori, Federica
AU - Bedogni, Francesco
AU - Testa, Luca
PY - 2016
Y1 - 2016
N2 - Background: Whether patients with reduced left ventricular function present worse outcome after transcatheter aortic valve implantation (TAVI) is controversial. The aim of this study was to assess the impact of baseline severe impairment of left ventricular ejection fraction (LVEF) on mortality after TAVI. Methods: Six-hundred-forty-nine patients with aortic stenosis underwent TAVI with the CoreValve system (92.8%) or the Edwards SAPIEN valve system (7.2%). Baseline LVEF was measured by the echocardiographic Simpson method. The impact of LVEF ≤ 30% on mortality was assessed by Cox regression. Results: Patients with LVEF ≤ 30% (n = 63), as compared to those with LVEF > 30% (n = 586), had a higher prevalence of NHYA class > 2 (P <0.001) and presented with a higher Euroscore (P <0.001). Procedural success was similar in both groups (98.4% vs. 97.2%, P = 1). After a median follow-up of 436 days (25th-75th percentile, 357-737 days), all-cause mortality [23.8% vs. 23.7%, P = 0.87, hazard ratios (HR): 0.96, 95% confidence intervals (CI): 0.56-1.63] and cardiac mortality (19.1% vs. 17.6%, P = 0.89, HR: 1.04, 95% CI: 0.57-1.90) were similar in patients with LVEF ≤ 30% as compared to those with LVEF > 30%. Thirty-day all-cause mortality was not significantly different between the two groups (11.1% vs. 6.3%, P = 0.14, HR: 1.81, 95% CI: 0.81-4.06). Patients with LVEF ≤ 30% had a trend toward higher risk of 30-day cardiac mortality (11.1% vs. 5.3%; P = 0.06, HR: 2.16, 95% CI: 0.95-4.90), which disappeared after multivariable adjustment (P = 0.22). Conclusions: Baseline severe impairment of LVEF is not a predictor of increased short-term and mid-term mortality after TAVI. Selected patients with severe impairment of left ventricular function should not be denied TAVI.
AB - Background: Whether patients with reduced left ventricular function present worse outcome after transcatheter aortic valve implantation (TAVI) is controversial. The aim of this study was to assess the impact of baseline severe impairment of left ventricular ejection fraction (LVEF) on mortality after TAVI. Methods: Six-hundred-forty-nine patients with aortic stenosis underwent TAVI with the CoreValve system (92.8%) or the Edwards SAPIEN valve system (7.2%). Baseline LVEF was measured by the echocardiographic Simpson method. The impact of LVEF ≤ 30% on mortality was assessed by Cox regression. Results: Patients with LVEF ≤ 30% (n = 63), as compared to those with LVEF > 30% (n = 586), had a higher prevalence of NHYA class > 2 (P <0.001) and presented with a higher Euroscore (P <0.001). Procedural success was similar in both groups (98.4% vs. 97.2%, P = 1). After a median follow-up of 436 days (25th-75th percentile, 357-737 days), all-cause mortality [23.8% vs. 23.7%, P = 0.87, hazard ratios (HR): 0.96, 95% confidence intervals (CI): 0.56-1.63] and cardiac mortality (19.1% vs. 17.6%, P = 0.89, HR: 1.04, 95% CI: 0.57-1.90) were similar in patients with LVEF ≤ 30% as compared to those with LVEF > 30%. Thirty-day all-cause mortality was not significantly different between the two groups (11.1% vs. 6.3%, P = 0.14, HR: 1.81, 95% CI: 0.81-4.06). Patients with LVEF ≤ 30% had a trend toward higher risk of 30-day cardiac mortality (11.1% vs. 5.3%; P = 0.06, HR: 2.16, 95% CI: 0.95-4.90), which disappeared after multivariable adjustment (P = 0.22). Conclusions: Baseline severe impairment of LVEF is not a predictor of increased short-term and mid-term mortality after TAVI. Selected patients with severe impairment of left ventricular function should not be denied TAVI.
KW - Left ventricular ejection fraction
KW - Mortality
KW - Transcatheter aortic valve implantation
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U2 - 10.11909/j.issn.1671-5411.2016.04.001
DO - 10.11909/j.issn.1671-5411.2016.04.001
M3 - Article
VL - 13
SP - 290
EP - 298
JO - Journal of Geriatric Cardiology
JF - Journal of Geriatric Cardiology
SN - 1671-5411
IS - 4
ER -