Effect of Baseline Left Ventricular Ejection Fraction on 2-Year Outcomes After Transcatheter Aortic Valve Replacement

Analysis of the PARTNER 2 Trials

Ariel Furer, Shmuel Chen, Bjorn Redfors, Sammy Elmariah, Philippe Pibarot, Howard C. Herrmann, Rebecca T. Hahn, Susheel Kodali, Vinod H. Thourani, Pamela S. Douglas, Maria C. Alu, William F. Fearon, Jonathan Passeri, S. Chris Malaisrie, Aaron Crowley, Thomas McAndrew, Philippe Genereux, Ori Ben-Yehuda, Martin B. Leon, Daniel Burkhoff

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Impaired left ventricular function is associated with worse prognosis among patients with aortic stenosis treated medically or with surgical aortic valve replacement. It is unclear whether reduced left ventricular ejection fraction (LVEF) is an independent predictor of adverse outcomes after transcatheter aortic valve replacement. METHODS AND RESULTS: Patients who underwent transcatheter aortic valve replacement in the PARTNER 2 trials (Placement of Aortic Transcatheter Valves) and registries were stratified according to presence of reduced LVEF (<50%) at baseline, and 2-year risk of cardiovascular mortality was compared using Kaplan-Meier methods and multivariable Cox proportional hazards regression. Of 2991 patients, 839 (28%) had reduced LVEF. These patients were younger, more often males, and were more likely to have comorbidities, such as coronary disease, diabetes mellitus, and renal insufficiency. Compared with patients with normal LVEF, patients with low LVEF had higher crude rates of 2-year cardiovascular mortality (19.8% versus 12.0%, P<0.0001) and all-cause mortality (27.4% versus 19.2%, P<0.0001). Mean aortic valve gradient was not associated with clinical outcomes other than heart failure hospitalizations (hazard ratio [HR], 0.99; CI, 0.99-1.00; P=0.03). After multivariable adjustment, patients with reduced versus normal LVEF had significantly higher adjusted risk of cardiovascular death (adjusted HR, 1.42, 95% CI, 1.11-1.81; P=0.005), but not all-cause death (adjusted HR, 1.20; 95% CI, 0.99-1.47; P=0.07). When LVEF was treated as continuous variable, it was associated with increased 2-year risk of both cardiovascular mortality (adjusted HR per 10% decrease in LVEF, 1.16; 95% CI, 1.07-1.27; P=0.0006) and all-cause mortality (adjusted HR, 1.09; 95% CI, 1.01-1.16; P=0.02). CONCLUSIONS: In this patient-level pooled analysis of PARTNER 2 patients who underwent transcatheter aortic valve replacement, baseline LVEF was an independent predictor of 2-year cardiovascular mortality. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01314313, NCT02184442, NCT03222128, and NCT02184441.

Original languageEnglish (US)
Pages (from-to)e005809
JournalCirculation. Heart failure
Volume12
Issue number8
DOIs
StatePublished - Aug 1 2019

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Stroke Volume
Mortality
Aortic Valve
Transcatheter Aortic Valve Replacement
Aortic Valve Stenosis
Left Ventricular Function
Surgical Instruments
Renal Insufficiency
Coronary Disease
Registries
Comorbidity
Cause of Death
Diabetes Mellitus
Hospitalization
Heart Failure
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Furer, Ariel ; Chen, Shmuel ; Redfors, Bjorn ; Elmariah, Sammy ; Pibarot, Philippe ; Herrmann, Howard C. ; Hahn, Rebecca T. ; Kodali, Susheel ; Thourani, Vinod H. ; Douglas, Pamela S. ; Alu, Maria C. ; Fearon, William F. ; Passeri, Jonathan ; Malaisrie, S. Chris ; Crowley, Aaron ; McAndrew, Thomas ; Genereux, Philippe ; Ben-Yehuda, Ori ; Leon, Martin B. ; Burkhoff, Daniel. / Effect of Baseline Left Ventricular Ejection Fraction on 2-Year Outcomes After Transcatheter Aortic Valve Replacement : Analysis of the PARTNER 2 Trials. In: Circulation. Heart failure. 2019 ; Vol. 12, No. 8. pp. e005809.
@article{e4992a248ba4479e8fb59109c2842751,
title = "Effect of Baseline Left Ventricular Ejection Fraction on 2-Year Outcomes After Transcatheter Aortic Valve Replacement: Analysis of the PARTNER 2 Trials",
abstract = "BACKGROUND: Impaired left ventricular function is associated with worse prognosis among patients with aortic stenosis treated medically or with surgical aortic valve replacement. It is unclear whether reduced left ventricular ejection fraction (LVEF) is an independent predictor of adverse outcomes after transcatheter aortic valve replacement. METHODS AND RESULTS: Patients who underwent transcatheter aortic valve replacement in the PARTNER 2 trials (Placement of Aortic Transcatheter Valves) and registries were stratified according to presence of reduced LVEF (<50{\%}) at baseline, and 2-year risk of cardiovascular mortality was compared using Kaplan-Meier methods and multivariable Cox proportional hazards regression. Of 2991 patients, 839 (28{\%}) had reduced LVEF. These patients were younger, more often males, and were more likely to have comorbidities, such as coronary disease, diabetes mellitus, and renal insufficiency. Compared with patients with normal LVEF, patients with low LVEF had higher crude rates of 2-year cardiovascular mortality (19.8{\%} versus 12.0{\%}, P<0.0001) and all-cause mortality (27.4{\%} versus 19.2{\%}, P<0.0001). Mean aortic valve gradient was not associated with clinical outcomes other than heart failure hospitalizations (hazard ratio [HR], 0.99; CI, 0.99-1.00; P=0.03). After multivariable adjustment, patients with reduced versus normal LVEF had significantly higher adjusted risk of cardiovascular death (adjusted HR, 1.42, 95{\%} CI, 1.11-1.81; P=0.005), but not all-cause death (adjusted HR, 1.20; 95{\%} CI, 0.99-1.47; P=0.07). When LVEF was treated as continuous variable, it was associated with increased 2-year risk of both cardiovascular mortality (adjusted HR per 10{\%} decrease in LVEF, 1.16; 95{\%} CI, 1.07-1.27; P=0.0006) and all-cause mortality (adjusted HR, 1.09; 95{\%} CI, 1.01-1.16; P=0.02). CONCLUSIONS: In this patient-level pooled analysis of PARTNER 2 patients who underwent transcatheter aortic valve replacement, baseline LVEF was an independent predictor of 2-year cardiovascular mortality. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01314313, NCT02184442, NCT03222128, and NCT02184441.",
author = "Ariel Furer and Shmuel Chen and Bjorn Redfors and Sammy Elmariah and Philippe Pibarot and Herrmann, {Howard C.} and Hahn, {Rebecca T.} and Susheel Kodali and Thourani, {Vinod H.} and Douglas, {Pamela S.} and Alu, {Maria C.} and Fearon, {William F.} and Jonathan Passeri and Malaisrie, {S. Chris} and Aaron Crowley and Thomas McAndrew and Philippe Genereux and Ori Ben-Yehuda and Leon, {Martin B.} and Daniel Burkhoff",
year = "2019",
month = "8",
day = "1",
doi = "10.1161/CIRCHEARTFAILURE.118.005809",
language = "English (US)",
volume = "12",
pages = "e005809",
journal = "Circulation: Heart Failure",
issn = "1941-3289",
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Furer, A, Chen, S, Redfors, B, Elmariah, S, Pibarot, P, Herrmann, HC, Hahn, RT, Kodali, S, Thourani, VH, Douglas, PS, Alu, MC, Fearon, WF, Passeri, J, Malaisrie, SC, Crowley, A, McAndrew, T, Genereux, P, Ben-Yehuda, O, Leon, MB & Burkhoff, D 2019, 'Effect of Baseline Left Ventricular Ejection Fraction on 2-Year Outcomes After Transcatheter Aortic Valve Replacement: Analysis of the PARTNER 2 Trials', Circulation. Heart failure, vol. 12, no. 8, pp. e005809. https://doi.org/10.1161/CIRCHEARTFAILURE.118.005809

Effect of Baseline Left Ventricular Ejection Fraction on 2-Year Outcomes After Transcatheter Aortic Valve Replacement : Analysis of the PARTNER 2 Trials. / Furer, Ariel; Chen, Shmuel; Redfors, Bjorn; Elmariah, Sammy; Pibarot, Philippe; Herrmann, Howard C.; Hahn, Rebecca T.; Kodali, Susheel; Thourani, Vinod H.; Douglas, Pamela S.; Alu, Maria C.; Fearon, William F.; Passeri, Jonathan; Malaisrie, S. Chris; Crowley, Aaron; McAndrew, Thomas; Genereux, Philippe; Ben-Yehuda, Ori; Leon, Martin B.; Burkhoff, Daniel.

In: Circulation. Heart failure, Vol. 12, No. 8, 01.08.2019, p. e005809.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of Baseline Left Ventricular Ejection Fraction on 2-Year Outcomes After Transcatheter Aortic Valve Replacement

T2 - Analysis of the PARTNER 2 Trials

AU - Furer, Ariel

AU - Chen, Shmuel

AU - Redfors, Bjorn

AU - Elmariah, Sammy

AU - Pibarot, Philippe

AU - Herrmann, Howard C.

AU - Hahn, Rebecca T.

AU - Kodali, Susheel

AU - Thourani, Vinod H.

AU - Douglas, Pamela S.

AU - Alu, Maria C.

AU - Fearon, William F.

AU - Passeri, Jonathan

AU - Malaisrie, S. Chris

AU - Crowley, Aaron

AU - McAndrew, Thomas

AU - Genereux, Philippe

AU - Ben-Yehuda, Ori

AU - Leon, Martin B.

AU - Burkhoff, Daniel

PY - 2019/8/1

Y1 - 2019/8/1

N2 - BACKGROUND: Impaired left ventricular function is associated with worse prognosis among patients with aortic stenosis treated medically or with surgical aortic valve replacement. It is unclear whether reduced left ventricular ejection fraction (LVEF) is an independent predictor of adverse outcomes after transcatheter aortic valve replacement. METHODS AND RESULTS: Patients who underwent transcatheter aortic valve replacement in the PARTNER 2 trials (Placement of Aortic Transcatheter Valves) and registries were stratified according to presence of reduced LVEF (<50%) at baseline, and 2-year risk of cardiovascular mortality was compared using Kaplan-Meier methods and multivariable Cox proportional hazards regression. Of 2991 patients, 839 (28%) had reduced LVEF. These patients were younger, more often males, and were more likely to have comorbidities, such as coronary disease, diabetes mellitus, and renal insufficiency. Compared with patients with normal LVEF, patients with low LVEF had higher crude rates of 2-year cardiovascular mortality (19.8% versus 12.0%, P<0.0001) and all-cause mortality (27.4% versus 19.2%, P<0.0001). Mean aortic valve gradient was not associated with clinical outcomes other than heart failure hospitalizations (hazard ratio [HR], 0.99; CI, 0.99-1.00; P=0.03). After multivariable adjustment, patients with reduced versus normal LVEF had significantly higher adjusted risk of cardiovascular death (adjusted HR, 1.42, 95% CI, 1.11-1.81; P=0.005), but not all-cause death (adjusted HR, 1.20; 95% CI, 0.99-1.47; P=0.07). When LVEF was treated as continuous variable, it was associated with increased 2-year risk of both cardiovascular mortality (adjusted HR per 10% decrease in LVEF, 1.16; 95% CI, 1.07-1.27; P=0.0006) and all-cause mortality (adjusted HR, 1.09; 95% CI, 1.01-1.16; P=0.02). CONCLUSIONS: In this patient-level pooled analysis of PARTNER 2 patients who underwent transcatheter aortic valve replacement, baseline LVEF was an independent predictor of 2-year cardiovascular mortality. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01314313, NCT02184442, NCT03222128, and NCT02184441.

AB - BACKGROUND: Impaired left ventricular function is associated with worse prognosis among patients with aortic stenosis treated medically or with surgical aortic valve replacement. It is unclear whether reduced left ventricular ejection fraction (LVEF) is an independent predictor of adverse outcomes after transcatheter aortic valve replacement. METHODS AND RESULTS: Patients who underwent transcatheter aortic valve replacement in the PARTNER 2 trials (Placement of Aortic Transcatheter Valves) and registries were stratified according to presence of reduced LVEF (<50%) at baseline, and 2-year risk of cardiovascular mortality was compared using Kaplan-Meier methods and multivariable Cox proportional hazards regression. Of 2991 patients, 839 (28%) had reduced LVEF. These patients were younger, more often males, and were more likely to have comorbidities, such as coronary disease, diabetes mellitus, and renal insufficiency. Compared with patients with normal LVEF, patients with low LVEF had higher crude rates of 2-year cardiovascular mortality (19.8% versus 12.0%, P<0.0001) and all-cause mortality (27.4% versus 19.2%, P<0.0001). Mean aortic valve gradient was not associated with clinical outcomes other than heart failure hospitalizations (hazard ratio [HR], 0.99; CI, 0.99-1.00; P=0.03). After multivariable adjustment, patients with reduced versus normal LVEF had significantly higher adjusted risk of cardiovascular death (adjusted HR, 1.42, 95% CI, 1.11-1.81; P=0.005), but not all-cause death (adjusted HR, 1.20; 95% CI, 0.99-1.47; P=0.07). When LVEF was treated as continuous variable, it was associated with increased 2-year risk of both cardiovascular mortality (adjusted HR per 10% decrease in LVEF, 1.16; 95% CI, 1.07-1.27; P=0.0006) and all-cause mortality (adjusted HR, 1.09; 95% CI, 1.01-1.16; P=0.02). CONCLUSIONS: In this patient-level pooled analysis of PARTNER 2 patients who underwent transcatheter aortic valve replacement, baseline LVEF was an independent predictor of 2-year cardiovascular mortality. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01314313, NCT02184442, NCT03222128, and NCT02184441.

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U2 - 10.1161/CIRCHEARTFAILURE.118.005809

DO - 10.1161/CIRCHEARTFAILURE.118.005809

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SP - e005809

JO - Circulation: Heart Failure

JF - Circulation: Heart Failure

SN - 1941-3289

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