Left Ventricular Ejection Fraction in Patients Undergoing Transcatheter Aortic Valve Implantation

BACKGROUND: Reduced LV ejection fraction (LVEF) in aortic stenosis may result from afterload mismatch or reduced contractility. Limited data exist on post-transcatheter aortic valve implantation (TAVI) LVEF changes and factors linked to persistent low LVEF. OBJECTIVES: The aim of this substudy was to identify variables associated with persistent low LVEF after TAVI. METHODS: The COMPARE-TAVI 1 trial is an all-comer study in which patients scheduled for transfemoral TAVI were randomized 1:1 to receive either the Sapien 3/Sapien 3 Ultra or Myval/Myval Octacor transcatheter heart valve. Patients were categorized into 2 groups based on their baseline LVEF: low LVEF (≤40%) or normal LVEF (>40%). Serial LVEF were analyzed alongside 12-month mortality. RESULTS: Of 1,029 patients, men comprised 60%. The mean LVEF was 55% ± 14%. Among patients with low baseline LVEF (n = 151, 15%), the mean LVEF improved from 31% ± 6% to 45% ± 15% at 1 month, and 52% ± 14% at 12 months (P < 0.001). However, 20% of these patients had persistent LVEF ≤40% at 1 year, while 5% of patients with normal baseline LVEF declined to ≤40%. Chronic heart failure, pacemaker pre-TAVI, baseline LVEF, left ventricular end-diastolic diameter, aortic mean gradient, and stroke volume index were associated with persistent low LVEF at 1 year. No significant differences in 1-year mortality were observed between groups. CONCLUSIONS: TAVI improves LVEF in the majority of patients with low baseline LVEF. However, a subset of patients experiences persistent left ventricular impairment, with chronic heart failure, pacemaker, and baseline LVEF as key predictors.