# Left Ventricular Ejection Fraction in Patients Undergoing Transcatheter Aortic Valve Implantation: Insights From the COMPARE-TAVI-1 Study

## TL;DR

This study finds that most patients with low heart function improve after a heart valve procedure, but some remain at risk due to factors like chronic heart failure and pacemaker use.

## Contribution

Identifies key predictors of persistent low heart function after TAVI in patients with initially reduced ejection fraction.

## Key findings

- 20% of patients with low baseline LVEF had persistent low LVEF at 1 year after TAVI.
- Chronic heart failure, pacemaker use, and baseline LVEF were key predictors of persistent low LVEF.
- No significant differences in 1-year mortality were observed between the two TAVI valve groups.

## Abstract

Reduced LV ejection fraction (LVEF) in aortic stenosis 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.

The aim of this substudy was to identify variables associated with persistent low LVEF after TAVI.

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 2 groups based on their baseline LVEF: low LVEF (≤40%) or normal LVEF (>40%). Serial LVEF were analyzed alongside 12-month mortality.

Of 1,029 patients, men comprised 60%. The mean LVEF was 55% ± 14%. Among patients with low baseline LVEF (n = 151, 15%), the mean LVEF improved from 31% ± 6% to 45% ± 15% at 1 month, and 52% ± 14% 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%. Chronic heart failure, pacemaker pre-TAVI, baseline LVEF, left ventricular end-diastolic diameter, aortic mean gradient, and stroke volume index were associated with persistent low LVEF at 1 year. No significant differences in 1-year mortality were observed between groups.

TAVI improves LVEF in the majority of patients with low baseline LVEF. However, a subset of patients experiences persistent left ventricular impairment, with chronic heart failure, pacemaker, and baseline LVEF as key predictors.