Abstract 10550: Higher Endocardial Viability Ratio is Associated With Improved Left Ventricular Function After Transcatheter Aortic Valve Replacement

Abstract

Introduction: Both LV dysfunction and AS lead to an increase in LVEDP, a decrease in oxygen delivery to cardiac muscle, and ultimately a decrease in the EVR. Hypothesis: We hypothesized that patients with low EVR would have less significant recovery of LV function after TAVR. Methods: Patients with LVEF <40% and severe AS undergoing TAVR at the University of Virginia (UVA) between 2012 and 2019 were retrospectively reviewed. EVR was calculated by dividing the diastolic pressure time index (DPTI) [(Diastolic blood pressure – LVEDP) x (60seconds/ heart rate – 0.2 seconds)] by the tension time index (TTI) [systolic pressure x 0.2 seconds] using catheter-derived hemodynamics prior to TAVR. LVEF and mAG values were obtained from TTE measurements done for procedural planning and at, or closest to, 1-year follow-up. The patients were divided into cohorts based on EVR above or below 0.7, a value indicative of subendocardial ischemia. Mean change in LVEF was evaluated between these two groups (Figure [1] and Table [1]) and multivariable regression was performed using pre-procedural LVEF, EVR, and change in mean aortic gradient as shown in Table [2]. Results: 128 patients that underwent TAVR had a LVEF <40%. 85 patients (32.5% female) had complete invasive hemodynamic and echocardiographic data. The mean change in post-TAVR LVEF in the lower subgroup was <5% with a standard deviation of 12.5. In patients with EVR >0.7 there was improvement of LVEF of >10% with a standard deviation of 10.8. Two-tailed t-testing was performed with a corresponding p-value of 0.0181. Multivariable regression on pre-procedural LVEF, pre-procedural EVR, and change in mean AG were all statistically significant. Conclusion: EVR >0.7 is associated with greater improvement in LV function in advanced heart failure patients after TAVR.