Early recovery of left ventricular systolic function after corevalve transcatheter aortic valve replacement

Harold L. Dauerman, Michael J. Reardon, Jeffrey J. Popma, Stephen H. Little, João L. Cavalcante, David H. Adams, Neil S. Kleiman, Jae Kuen Oh

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background - Approximately one third of patients with symptomatic aortic stenosis have reduced left ventricular ejection fraction (LVEF) before transcatheter aortic valve replacement. The incidence, predictors, and significance of early LVEF recovery after CoreValve transcatheter aortic valve replacement have not been described. Methods and Results - We studied 156 patients from the CoreValve Extreme and High-Risk trials with LVEF ≤40% at baseline who had 30-day LVEF data. All patients underwent core laboratory echocardiographic assessment of LVEF at baseline, post procedure, discharge, 30 days, 6 months, and 1 year. Early LVEF recovery was defined as an absolute increase of ≥10% in EF at 30 days. One-year outcomes were compared between patients with and without early recovery. Multivariable analysis was performed to determine independent predictors of early recovery. Early LVEF recovery occurred in 62% of patients, generally before discharge. By 30 days LVEF increased >17% compared with baseline in the early recovery group with minimal increase in the no-early recovery group (48.9±8.8% versus 31.5±6.9%; P<0.001). One-year all-cause mortality was numerically (but not statistically) higher in the no-early recovery group (24% versus 12%; P=0.07). Absence of previous myocardial infarction (odds ratio, 0.44; 95% confidence interval, 0.19-1.03) and baseline mean gradient ≥40 mm Hg (odds ratio, 4.59; 95% confidence interval, 1.76-11.96) were identified as predictors of early LVEF recovery. Conclusions - Nearly two thirds of patients with reduced LVEF will have a marked early improvement after transcatheter aortic valve replacement. Early LVEF recovery is associated with improved clinical outcomes and is most likely among patients with higher baseline aortic valve gradients and no previous myocardial infarction.

Original languageEnglish (US)
Article numbere003425
JournalCirculation: Cardiovascular Interventions
Volume9
Issue number6
DOIs
StatePublished - Jun 1 2016

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Left Ventricular Function
Stroke Volume
Transcatheter Aortic Valve Replacement
Odds Ratio
Myocardial Infarction
Confidence Intervals
Aortic Valve Stenosis
Aortic Valve
Mortality
Incidence

Keywords

  • aortic valve stenosis
  • myocardial infarction
  • stroke volume
  • transcatheter aortic valve replacement
  • ventricular function, left

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Early recovery of left ventricular systolic function after corevalve transcatheter aortic valve replacement. / Dauerman, Harold L.; Reardon, Michael J.; Popma, Jeffrey J.; Little, Stephen H.; Cavalcante, João L.; Adams, David H.; Kleiman, Neil S.; Oh, Jae Kuen.

In: Circulation: Cardiovascular Interventions, Vol. 9, No. 6, e003425, 01.06.2016.

Research output: Contribution to journalArticle

Dauerman, Harold L. ; Reardon, Michael J. ; Popma, Jeffrey J. ; Little, Stephen H. ; Cavalcante, João L. ; Adams, David H. ; Kleiman, Neil S. ; Oh, Jae Kuen. / Early recovery of left ventricular systolic function after corevalve transcatheter aortic valve replacement. In: Circulation: Cardiovascular Interventions. 2016 ; Vol. 9, No. 6.
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AU - Dauerman, Harold L.

AU - Reardon, Michael J.

AU - Popma, Jeffrey J.

AU - Little, Stephen H.

AU - Cavalcante, João L.

AU - Adams, David H.

AU - Kleiman, Neil S.

AU - Oh, Jae Kuen

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N2 - Background - Approximately one third of patients with symptomatic aortic stenosis have reduced left ventricular ejection fraction (LVEF) before transcatheter aortic valve replacement. The incidence, predictors, and significance of early LVEF recovery after CoreValve transcatheter aortic valve replacement have not been described. Methods and Results - We studied 156 patients from the CoreValve Extreme and High-Risk trials with LVEF ≤40% at baseline who had 30-day LVEF data. All patients underwent core laboratory echocardiographic assessment of LVEF at baseline, post procedure, discharge, 30 days, 6 months, and 1 year. Early LVEF recovery was defined as an absolute increase of ≥10% in EF at 30 days. One-year outcomes were compared between patients with and without early recovery. Multivariable analysis was performed to determine independent predictors of early recovery. Early LVEF recovery occurred in 62% of patients, generally before discharge. By 30 days LVEF increased >17% compared with baseline in the early recovery group with minimal increase in the no-early recovery group (48.9±8.8% versus 31.5±6.9%; P<0.001). One-year all-cause mortality was numerically (but not statistically) higher in the no-early recovery group (24% versus 12%; P=0.07). Absence of previous myocardial infarction (odds ratio, 0.44; 95% confidence interval, 0.19-1.03) and baseline mean gradient ≥40 mm Hg (odds ratio, 4.59; 95% confidence interval, 1.76-11.96) were identified as predictors of early LVEF recovery. Conclusions - Nearly two thirds of patients with reduced LVEF will have a marked early improvement after transcatheter aortic valve replacement. Early LVEF recovery is associated with improved clinical outcomes and is most likely among patients with higher baseline aortic valve gradients and no previous myocardial infarction.

AB - Background - Approximately one third of patients with symptomatic aortic stenosis have reduced left ventricular ejection fraction (LVEF) before transcatheter aortic valve replacement. The incidence, predictors, and significance of early LVEF recovery after CoreValve transcatheter aortic valve replacement have not been described. Methods and Results - We studied 156 patients from the CoreValve Extreme and High-Risk trials with LVEF ≤40% at baseline who had 30-day LVEF data. All patients underwent core laboratory echocardiographic assessment of LVEF at baseline, post procedure, discharge, 30 days, 6 months, and 1 year. Early LVEF recovery was defined as an absolute increase of ≥10% in EF at 30 days. One-year outcomes were compared between patients with and without early recovery. Multivariable analysis was performed to determine independent predictors of early recovery. Early LVEF recovery occurred in 62% of patients, generally before discharge. By 30 days LVEF increased >17% compared with baseline in the early recovery group with minimal increase in the no-early recovery group (48.9±8.8% versus 31.5±6.9%; P<0.001). One-year all-cause mortality was numerically (but not statistically) higher in the no-early recovery group (24% versus 12%; P=0.07). Absence of previous myocardial infarction (odds ratio, 0.44; 95% confidence interval, 0.19-1.03) and baseline mean gradient ≥40 mm Hg (odds ratio, 4.59; 95% confidence interval, 1.76-11.96) were identified as predictors of early LVEF recovery. Conclusions - Nearly two thirds of patients with reduced LVEF will have a marked early improvement after transcatheter aortic valve replacement. Early LVEF recovery is associated with improved clinical outcomes and is most likely among patients with higher baseline aortic valve gradients and no previous myocardial infarction.

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KW - myocardial infarction

KW - stroke volume

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KW - ventricular function, left

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