Changes in left ventricular ejection fraction in patients undergoing transcatheter aortic valve implantation: insights from the COMPARE-TAVI 1 study

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Abstract Background Reduced left ventricular ejection fraction (LVEF) in aortic stenosis (AS) 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. Purpose 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 two groups based on their baseline LVEF: Low LVEF (≤ 40%) or Normal LVEF (>40%). Serial LVEF were analyzed alongside 12-month mortality. Results Of 1031 patients with mean age of 81 (±6) years, men comprised 60%. The mean LVEF was 55.1±13.7%. Among patients with low baseline LVEF (n=151, 15%), mean LVEF improved from 30.9±6.3% to 44.8±14.8 % at 1 month, and 52.2±13.6% 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% (Figure). Chronic heart failure (CHF), pacemaker pre-TAVI or within 30 days post-TAVI, baseline LVEF, left ventricular end-diastolic diameter, aortic mean gradient, and stroke volume index were associated with persistent low LVEF at 1-year in multivariate logistic regression model (Table). No significant differences in 1-year mortality were observed between groups (7.3% vs 5.7% in Low LVEF vs. Normal LVEF group, respectively, p=0.43). Conclusion TAVI improves LVEF in patients with aortic stenosis and low baseline LVEF. However, a subset of patients experiences persistent LV impairment, with CHF, pacemaker, and baseline LVEF as key predictors. Figure

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