TY - JOUR
T1 - Influence of baseline ejection fraction on the prognostic value of paravalvular leak after transcatheter aortic valve implantation
AU - Miyazaki, Sakiko
AU - Agricola, Eustachio
AU - Panoulas, Vasileios F.
AU - Slavich, Massimo
AU - Giustino, Gennaro
AU - Miyazaki, Tadashi
AU - Figini, Filippo
AU - Latib, Azeem
AU - Chieffo, Alaide
AU - Montorfano, Matteo
AU - Margonato, Alberto
AU - Maisano, Francesco
AU - Alfieri, Ottavio
AU - Colombo, Antonio
PY - 2015/7/1
Y1 - 2015/7/1
N2 - Background: Moderate or severe paravalvular leak (PVL ≥ moderate) after transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. The aim of this study was to assess whether the baseline ejection fraction (EF) affects the impact of PVL on mortality after TAVI. Methods: Weanalyzed 514 consecutive patients with native severe aortic stenosis who underwent TAVI. Patients were divided into two groups: EF b40% group (n = 84) and EF ≥40% group (n = 430) according to baseline EF. Results: The mean age was 79.5 years and 49% were male. Patients in the EF b40% group were younger and with higher logistic EuroSCORE compared to patients in the EF ≥40% group. Diabetes, coronary artery disease, atrial fibrillation and renal insufficiency were more prevalent in the EF b40% group. Patients in the EF b40% group had more mitral regurgitation. In-hospital mortality was significantly higher in the EF b40% group (8.3% vs. 0.9%, p b 0.0001). PVL ≥ moderate was significantly associated with increased 2-year estimated mortality only in the EF b40% group (65% vs. 20%, log-rank p b 0.0001) whereas no difference was seen in the EF ≥40% group (24% vs. 19%, log-rank p = 0.509). Interaction between PVL ≥ moderate and EF b40% was statistically significant. Conclusions: The impact of PVL ≥moderateonmortality after TAVI was significantin the EF b40% group but not in the EF ≥40% group in our study. Even though operators should aim to minimize PVL in all TAVI patients, special attention is required for patients with reduced baseline EF.
AB - Background: Moderate or severe paravalvular leak (PVL ≥ moderate) after transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. The aim of this study was to assess whether the baseline ejection fraction (EF) affects the impact of PVL on mortality after TAVI. Methods: Weanalyzed 514 consecutive patients with native severe aortic stenosis who underwent TAVI. Patients were divided into two groups: EF b40% group (n = 84) and EF ≥40% group (n = 430) according to baseline EF. Results: The mean age was 79.5 years and 49% were male. Patients in the EF b40% group were younger and with higher logistic EuroSCORE compared to patients in the EF ≥40% group. Diabetes, coronary artery disease, atrial fibrillation and renal insufficiency were more prevalent in the EF b40% group. Patients in the EF b40% group had more mitral regurgitation. In-hospital mortality was significantly higher in the EF b40% group (8.3% vs. 0.9%, p b 0.0001). PVL ≥ moderate was significantly associated with increased 2-year estimated mortality only in the EF b40% group (65% vs. 20%, log-rank p b 0.0001) whereas no difference was seen in the EF ≥40% group (24% vs. 19%, log-rank p = 0.509). Interaction between PVL ≥ moderate and EF b40% was statistically significant. Conclusions: The impact of PVL ≥moderateonmortality after TAVI was significantin the EF b40% group but not in the EF ≥40% group in our study. Even though operators should aim to minimize PVL in all TAVI patients, special attention is required for patients with reduced baseline EF.
KW - 2-Year mortality
KW - Aortic stenosis
KW - Left ventricular ejection fraction
KW - Paravalvular leak
KW - Transcatheter aortic valve implantation
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U2 - 10.1016/j.ijcard.2015.04.190
DO - 10.1016/j.ijcard.2015.04.190
M3 - Article
C2 - 25932806
AN - SCOPUS:84929149904
VL - 190
SP - 277
EP - 281
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
IS - 1
ER -