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Impact of severe left ventricular dysfunction on mid-term mortality in elderly patients undergoing transcatheter aortic valve implantation

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Journal of Geriatric Cardiology 2016年第4期13卷 290-298页

作者： Giuseppe Ferrante Patrizia Presbitero Paolo Pagnotta Anna Sonia Petronio Nedy Brambilla Federico De Marco Claudia Fiorina cristina giannini Fabrizio D'Ascenzo Silvio Klugmann Marco L Rossi Federica Ettori Francesco Bedogni Luca Testa Department of Cardiovascular Medicine Humanitas Research Hospital Rozzano Italy Cardiothoracic and Vascular Department Azienda Ospedaliero-Universitaria Pisana Pisa Italy Department of Cardiology IRCCS Pol. S. Donato S. Donato Milanese Milan Italy Department of lnterventional Cardiology Niguarda Ca' Granda Hospital Milan Italy Cardiothoracic Department Spedali Civili di Brescia Brescia Italy Cardiothoracic Department Ospedale Molinette Torino Italy

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 （25^-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： 0.814.06）. 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.

关键词： Left ventricular ejection fraction Mortality Transcatheter aortic valve implantation

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