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Transcatheter aortic valve implantation in patients with a reduced left ventricular ejection fraction: a single-centre experience in 2000 patients (TAVIK Registry)

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Abstract

Background

Previous studies into the effect of a reduced left ventricular ejection fraction (EF) on the short- and long-term prognosis of patients undergoing transcatheter aortic valve implantation (TAVI) have reported conflicting findings. We analysed data from the Karlsruhe TAVI registry with the aim of addressing this question.

Methods and results

Patients with aortic stenosis undergoing TAVI were divided into sub-groups according to EF: severely reduced (<30%; n = 109), reduced (≥30 and ≤40%; n = 201), and mid-range/preserved (>40%; n = 1690). VARC complications at 30 days for the population with severely reduced EF did not differ in comparison to the patients with mid-range/preserved EF. Patients with severely reduced EF had a significantly lower survival at 48 h (91.7 vs. 99.0%; p < 0.001), at 30 days (84.4 vs. 95.8%; p < 0.001) and at 1 year (66.1 vs. 85.0%, p < 0.001) compared to those with mid-range/preserved EF. The risk of death increased with age, peripheral arterial disease, poor self-care and chronic renal failure in patients with severely reduced EF.

Conclusions

Mortality post-TAVI was higher for patients with a reduced EF, although the excess comorbidity burden likely contributed to this. A reduced EF should not be considered a contraindication for TAVI per se, but the additional presence of comorbidity indicates increased risk for these patients.

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Author information

Author notes

  1. Gerhard Schymik and Panagiotis Tzamalis contributed equally.

Authors and Affiliations

  1. Medical Clinic IV, Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Moltkestrasse 90, 76133, Karlsruhe, Germany

    Gerhard Schymik, Panagiotis Tzamalis, Valentin Herzberger, Jens Bergmann & Armin Luik

  2. Institute for Pharmacology and Preventive Medicine, Mahlow, Germany

    Peter Bramlage

  3. Medical Clinic III, Department of Cardiology, Vincentius Hospital Karlsruhe, Karlsruhe, Germany

    Alexander Würth

  4. Helios Clinic for Cardiac Surgery Karlsruhe, Karlsruhe, Germany

    Lars Oliver Conzelmann

  5. Department of Cardiovascular Surgery, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany

    Holger Schröfel

Authors
  1. Gerhard Schymik
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  2. Panagiotis Tzamalis
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  3. Valentin Herzberger
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  4. Jens Bergmann
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  5. Peter Bramlage
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  6. Alexander Würth
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  7. Lars Oliver Conzelmann
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  8. Armin Luik
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  9. Holger Schröfel
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Contributions

All authors except PB established, and conducted the registry. GS, PB, and PT designed the statistical approach, analysis and interpretation. GS, PT, and PB, drafted the first version of the manuscript, which all other authors revised for important intellectual content. All authors approved the final version of the manuscript to be submitted.

Corresponding author

Correspondence to Gerhard Schymik.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

Gerhard Schymik and Holger Schröfel are proctors and Peter Bramlage is a consultant for Edwards Lifesciences. All other authors declare that they have no conflict of interest.

Electronic supplementary material

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392_2017_1151_MOESM1_ESM.tif

ROC Curve of the EF in comparison with mortality at the end of the first year after TAVI. Legend: Ejection fraction shows high sensitivity but low specificity. The c-statistic for the EF on the ROC-Curve was 0.598 ± 0.018 (p value < 0.001, 95% CI 0.564-0.633), indicating poor utility as a test. EFs of 30% and 40% also had low positive and negative predictive values (1.077 and 0.387, and 1.114 and 0.522, respectively) (TIFF 415 kb)

Supplementary material 2 (DOCX 20 kb)

Supplementary material 3 (DOCX 17 kb)

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Schymik, G., Tzamalis, P., Herzberger, V. et al. Transcatheter aortic valve implantation in patients with a reduced left ventricular ejection fraction: a single-centre experience in 2000 patients (TAVIK Registry). Clin Res Cardiol 106, 1018–1025 (2017). https://doi.org/10.1007/s00392-017-1151-9

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