Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
TAVI in patients with reduced left ventricular ejection fraction and severe or non-severe aortic stenosis: Results from the international ATLAS TAVI Registry
S. Ludwig1, G. Jean2, W.-K. Kim3, M. Renker3, C. W. Hamm4, M. Urena Alcazar5, M. Abdel-Wahab6, H. Thiele6, N. Van Mieghem7, J. Ooms7, M. Wiessmann8, R. Kornowski8, J. Dahl9, N. Mogensen9, B. Longere10, A. Coisne10, W. Ben Ali11, M. Seiffert12, H. Reichenspurner13, S. Blankenberg14, L. Conradi13, D. Westermann15, M.-A. Clavel2, N. Schofer15, für die Studiengruppe: ATLAS TAVI
1Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 2Institut universitaire de cardiologie et de pneumologie, Université Laval, Québec, CA; 3Abteilung für Kardiologie, Kerckhoff Klinik GmbH, Bad Nauheim; 4Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen; 5Department of Cardiology, Bichat-Claude Bernard Hospital, Paris, FR; 6Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; 7Thoraxcenter, Department of Experimental Echocardiographie, Erasmus MC, Rotterdam, NL; 8Department of Cardiology, Rabin Medical Center, Tel-Aviv University, Tel-Aviv, IL; 9Department of Cardiology, Odense University Hospital, Odense; 10Department of Cardiovascular Imaging, CHU Lille, Lille, FR; 11Montreal Heart Institute, Montréal, CA; 12Klinik und Poliklinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 13Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 14Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum UKE Hamburg GmbH, Hamburg; 15Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg;

Background: Patients with reduced left ventricular ejection fraction (LVEF), small aortic valve area and low gradient (LG) (<40 mmHg) may have severe or moderate aortic stenosis (AS). The impact of transcatheter aortic valve implantation (TAVI) is controversial in this population.

Methods: Patients with LG AS and LVEF <50% were included in a multinational TAVI registry (ATLAS TAVI). AS severity was assessed with the use of aortic valve calcification measured on non-contrast computed tomography (according to sex-specific thresholds of 1,200 arbitrary units (AU) in women and 2,000 AU in men). LG AS patients who underwent TAVI were divided in two groups: TAVI-LG-severe AS and TAVI-LG-non-severe AS. TAVI-high-gradient AS patients and moderate AS patients on medical management (Medical-Mod AS) were included as control groups. Inverse propensity weighting was applied for the comparison of TAVI-LG-non-severe AS and Medical-Mod AS.

Results: Among a total of 1,568 patients, 1047 underwent TAVI (TAVI-high-gradient AS, N=313; TAVI-LG-severe AS, N=527; TAVI-LG-non-severe AS, N=207) and 521 patients continued medical management (Medical-Mod AS) (Table 1). During a median follow-up of 3.38 (IQR: 1.40 – 5.63) years, there were 521 deaths. After comprehensive adjustment, all TAVI groups showed superior survival compared to Medical-Mod AS patients (all p<0.001). TAVI-LG-severe and TAVI-LG-non-severe AS patients showed similar survival (p=0.84) (Figure 1). After inverse propensity weighting between TAVI-LG-non-severe AS patients and Medical-Mod AS patients, TAVI was associated with improved survival (IPW-HR: 0.57 [0.34-0.94]; p=0.03).  

Conclusion: Among patients with AS and reduced LVEF, TAVI was a major predictor of survival in both severe and non-severe LG AS patients. These results reinforce the need of a randomized controlled trial to assess the impact of TAVI versus medical management in non-severe AS patients with low LVEF.
https://dgk.org/kongress_programme/jt2022/aV1425.html