Abstract 14482: Low Baseline Gradient is a Predictor of Increased Risk of Mortality Following Transcatheter Aortic Valve Replacement in Patients with Reduced Left Ventricular Ejection Fraction but not in those with Preserved Left Ventricular Ejection Fraction
Background: Low-flow, low-gradient AS is often associated with worse outcomes following surgical aortic valve replacement (AVR), especially in patients with reduced LV ejection fraction (LVEF). The objective of this study was to assess the impact of baseline LVEF and transvalvular gradient on outcomes following transcatheter AVR (TAVR).
Methods: We analyzed the clinical and echocardiographic data of 348 consecutive patients who underwent TAVR (160 transfemoral; 188 transapical) with the Edwards SAPIEN or SAPIEN XT valves from 2 Canadians centers between January 2005 and December 2010. The patients were divided into 4 groups: 1-Normal LVEF (≥50%) - high gradient (Mean Gradient, MG≥40 mmHg) (NEF-HG); 2-Normal LVEF (≥50%) - low gradient (MG<40 mmHg) (NEF-LG); 3-Low LVEF (<50%) - high gradient (LEF-HG); 4-Low LVEF - low gradient (LEF-LG).
Results: Mean age was 81±8 years, 156 (44.8%) were male with a mean Logistic EuroSCORE of 26.6% and mean LVEF at 55±14% (25% of patients had a LVEF≤50%). During a mean follow-up of 23±17 months, 132 deaths occured. Outcomes of the 4 groups are presented in the Table. The independent predictors of all-cause mortality were lower body mass index (Hazard Ratio [HR]=1.05 per 1kg/m² BMI decrease; p=0.04), atrial fibrillation (HR=1.66; p=0.006), chronic obstructive pulmonary disease (HR=1.83; p=0.003), glomerular filtration rate (HR=1.14 per 10ml/min decrease; p=0.003), pulmonary hypertension (HR=1.69; p=0.01) and lower MG at baseline (HR=1.16 per 10mmHg decrease; p=0.047). LVEF did not come out as a significant predictor of outcomes and there was a significant interaction between LVEF and gradient with regards to impact on mortality.
Conclusion: Low transvalvular gradient at baseline is an independent predictor of increased risk of mortality following TAVR, whereas reduced LVEF is not. Nonetheless, the association between low gradient and increased mortality was observed only in the subset of patients with reduced LVEF.
- © 2012 by American Heart Association, Inc.