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Preprocedural valvuloarterial impedance as a predictor of left ventricular ejection fraction improvement after transcatheter aortic valve replacement in patients with reduced left ventricular ejection fraction

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Abstract

Background

Predictors of left ventricular ejection fraction (LVEF) improvement after transcatheter aortic valve replacement (TAVR) in patients with a preoperative reduced LVEF are limited.

Objectives

This study aimed to investigate the relationship between preprocedural valuvuloarterial impedance (ZVa), which represents the global LV afterload, and LVEF improvement after TAVR.

Methods

This was a single-center, retrospective study, which included patients with symptomatic aortic valve stenosis (AS) with a reduced baseline LVEF (< 50%) underwent TAVR. Based on the difference in the LVEF before and 1 month after the procedure, they were divided into two groups: improved group (≥ 10% improvement) and non-improved group (< 10% improvement or worsening). Preprocedural ZVa and clinical outcomes were then compared. ZVa was calculated using preprocedural transthoracic echocardiography data.

Results

Among 473 cases of TAVR performed from May 2012 to July 2017 at Queen’s Medical Center (Honolulu, HI, USA), 99 patients (improved group, n = 42; mean age 82.0 ± 8.6 years vs. non-improved group, n = 57, mean age 81.4 ± 9.5 years) were included. The improved group had a higher baseline ZVa {4.83 (4.15–6.89) mmHg/ml/m2 vs. 4.04 (3.56–4.63) mmHg/ml/m2, respectively, p = 0.0009} and prevalence of ZVa > 5 mmHg/ml/m2 (45.2% vs. 17.5%, respectively, p = 0.0028). Multivariable analysis of predictors of LVEF improvement ≥ 10% at 1 month identified ZVa > 5 mmHg/ml/m2 [odds ratio (OR): 3.31, 95% confidence interval (CI): 1.05–11.8] as a predictor. The improved group had a lower readmission rate due to heart failure than the non-improved group (log-rank test, p = 0.043).

Conclusion

In conclusion, Zva is a simple, noninvasive marker that shows promise as a predictor of LVEF improvement after TAVR in reduced LVEF patients.

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Acknowledgements

The authors are indebted to Drs. Ramy Badawi, MD, and Jared Oyama, MD, and Mrs. Mio Osaki APRN and Vicky Crowder APRN for their care of the patients and Mrs. Sharon Uyeno for her contribution to the TVT registry data management.

Funding

This manuscript did not receive any grant or financial support.

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Authors and Affiliations

  1. Cardiovascular Interventional & Surgical Services, The Queen’s Medical Center, 550 South Beretania Street, Suite 702, Honolulu, HI, 96813, USA

    Ikki Komatsu, Chari Hart, Jeffrey Lau & Christian Spies

  2. Department of Cardiology, Tokyo Medical University, 6-7-1 Nishishinjyuku, Shinjyuku, Tokyo, 1600023, Japan

    Ikki Komatsu

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  1. Ikki Komatsu
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  2. Chari Hart
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  3. Jeffrey Lau
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Contributions

IK and CS analyzed the data and drafted the manuscript. CH and JL contributed equally to analyzing the data and editing the manuscript.

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Correspondence to Ikki Komatsu.

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Conflict of interest

Christian Spies, MD, is a consultant and TAVR proctor for Medtronic and Edwards Lifesciences. All other authors have no potential conflicts of interest to disclose with regard to any part of the data or results in this report.

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Komatsu, I., Hart, C., Lau, J. et al. Preprocedural valvuloarterial impedance as a predictor of left ventricular ejection fraction improvement after transcatheter aortic valve replacement in patients with reduced left ventricular ejection fraction. Heart Vessels 35, 1209–1217 (2020). https://doi.org/10.1007/s00380-020-01591-3

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  • DOI: https://doi.org/10.1007/s00380-020-01591-3

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