Abstract 14064: Echocardiographic Parameters Predicting Left Ventricular Ejection Fraction Improvement Following Transcatheter Aortic Valve Replacement

Abstract

Introduction: There is limited data available in terms of identifying echocardiographic parameters predicting improvement in left ventricular ejection fraction (LVEF) following a transcatheter aortic valve replacement (TAVR). Additionally, association of baseline cardiac disease burden with normal post-TAVR LVEF is poorly understood. Hypothesis: Higher baseline cardiac disease burden is associated with lower rates of normal post-TAVR LVEF. Methods: We retrospectively studied 352 consecutive patients who underwent TAVR at our institute, and who had 30-day follow-up data available. The patients were divided into two groups: pre-TAVR LVEF < 50% and ≥ 50%. We defined improvement in LVEF as a binary variable by studying for absolute improvement of +5% in LVEF on the 30-day post-TAVR echocardiogram. Furthermore, baseline cardiac disease burden was defined as a composite ordinal score of LVEF, severity of mitral regurgitation, mitral stenosis, coronary artery disease, tricuspid regurgitation, and pulmonary hypertension. Results: There was a significant difference in improvement of LVEF between the two pre-TAVR LVEF groups < 50% versus ≥ 50% (67% vs. 31%, p < 0.0001). On multivariate logistic regression analysis of pre-TAVR echocardiographic parameters, clinical variables and TAVR valve-related variables, only aortic valve (AV) area index (r = 3.86, p = 0.004), LV end-diastolic dimension (r = -0.74, p = 0.005), aortic regurgitation severity (r = 1.10, p = 0.010) and 29-mm valve size (r = -1.09, p = 0.021) were significant in predicting improvement in LVEF post-TAVR. LVEF was a weak predictor on multivariate logistic regression model (r = -0.11, p < 0.0001). Furthermore, patients with a higher baseline cardiac disease burden (defined as ≥ median composite score of 7) were significantly associated with lower rates of post-TAVR LVEF ≥ 50% (OR = 5.22 [2.49 - 10.96]; p < 0.0001). Conclusions: Higher baseline cardiac disease burden is significantly associated with lower rates of post-TAVR LVEF ≥ 50%. Additionally, specific echocardiographic parameters can predict improvement in LVEF following TAVR.