SPC365

Predictors of Left Ventricular Dysfunction Recovery One Year After TAVR in Patients with Pre-Existing Left Ventricular Dysfunction (LVEF > 50%)

Session: SESSÃO DE POSTERS 24 - COMPLICAÇÕES NA INTERVENÇÃO VALVULAR AÓRTICA PERCUTÂNEA
Speaker: Fernando Nascimento Ferreira

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.4 Valvular Heart Disease – Treatment
Session Type: Cartazes
FP Number: ---
Authors: Fernando Nascimento Ferreira; Francisco Albuquerque; Inês Rodrigues; Miguel Figueiredo; Barbara Teixeira; Francisco Cardoso; Mariana Caetano Coelho; Tiago Mendonça; Ruben Ramos; António Fiarresga; Rui Cruz Ferreira; Duarte Cacela

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction</span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">: Transcatheter aortic valve replacement (TAVR) has emerged as an effective treatment for patients with severe aortic stenosis. Although TAVR has been shown to improve left ventricular ejection fraction (LVEF), left ventricular dysfunction, often defined by a reduced LVEF, is a significant predictor of poor outcomes. Identifying factors that predict the maintenance of reduced LVEF (rLVEF) following TAVR is crucial, as persistent LVEF reduction is associated with poorer long-term outcomes. </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Objective:</span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> To identify pre-procedural predictors of sustained rLVEF in the medium term after TAVR and assess its prognostic impact.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods</span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">: A retrospective cohort study including patients who underwent echocardiographic re-evaluation one year after TAVR at a tertiary hospital between 2018 and 2023, with pre-existing left ventricular dysfunction (LVEF &lt; 50%). Baseline clinical characteristics and echocardiographic measurements were collected at the time of the procedure. Follow-up echo were performed to reassess LVEF. Univariate analysis, including chi-square and independent t-tests, as well as a logistic regression model, Kaplan-Meier survival curves and Cox proportional hazards regression were used. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A p-value &lt; 0.05 was considered statistically significant.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results</span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">: A total of 97 patients were included in the analysis, to groups were formed based on LVEF&lt;50% on midterm follow up. 36 (37,1%) pt had an LVEF &lt; 50%. Patients who maintained rLVEF were significantly younger and male (mean age 77&plusmn;8,4 Vs 82&plusmn;5,5 years, p = 0,048; male sex 33 Vs 54%, p=0,048). There were no significant differences the 2 groups regarding sex, comorbidities, and medication use. Additionally, patients with sustained reduced LVEF had a lower pre-TAVR LVEF (35,4 &plusmn;9,5% vs. 40,7 &plusmn;7,4%, p = 0,001) and mean aortic valve gradient (35,4 &plusmn;12mmHg vs. 45 &plusmn;13,4mmHg, p = 0,001). Logistic regression analysis identified age (OR = 0,882, 95% CI: 0.803 - 0.969, p = 0,009) and mean AV gradient (OR = 0,957, 95% CI: 0.917 - 0.999, p = 0,47) as independent factors associated with a lower likelihood of maintaining rLVEF. Kaplan-Meier survival analysis demonstrated that patients with sustained rLVEF had significantly higher all-cause mortality (HR 2,68 (1,052 - 6,811), p=0,039) and cardiovascular hospitalizations (HR 9,195 (2,037 - 18,843), p=0,001). </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion</span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">: This study found that patients who maintained reduced LVEF post-TAVR had worse long-term outcomes, including higher all-cause mortality and cardiovascular hospitalizations. Younger age and a lower mean AV mean gradient were identified as factors linked to sustained rLVEF. These results highlight the importance of assessing pre-procedural characteristics to predict which patients are at risk for persistent reduced LVEF. Further research is needed to refine these predictors and improve post-procedural management strategies.</span></span></span></span></span></p>