Pre‐Procedural Prediction of Left Ventricular Ejection Fraction Normalization After Transcatheter Aortic Valve Implantation

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an established therapy for severe aortic stenosis. Among patients with left ventricular (LV) systolic dysfunction, recovery of LV function after TAVI is heterogeneous, and reliable tools for pre-procedural risk stratification and patient counseling remain limited. AIMS: We sought to identify simple pre-procedural predictors of complete LV functional recovery after TAVI and to develop a clinically applicable risk score to support patient counseling and post-procedural management. METHODS: We retrospectively analyzed patients with severe aortic stenosis and baseline LV ejection fraction (LVEF) < 40% enrolled in a large multicenter registry in Japan. The primary outcome was complete LVEF normalization (LVEF > 50%) at 1 year after TAVI. Independent predictors were identified using multivariable logistic regression in a derivation cohort, and an exploratory weighted score was constructed. The score was preliminarily assessed in a separate single-center cohort. RESULTS: The derivation cohort comprised 177 patients (median age 84 years; 44% women), of whom 94 (53%) achieved LVEF normalization. Lower body mass index (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.77-0.95; p = 0.004), higher aortic valve peak velocity (OR 2.45, 95% CI 1.40-4.29; p = 0.002), and smaller LV end-diastolic diameter (OR 0.93, 95% CI 0.88-0.98; p = 0.020) were independently associated with LVEF normalization. The derived score stratified patients into low-, intermediate-, and high-probability groups (15%, 45%, and 71%, respectively; p < 0.001), with consistent discrimination in the validation cohort. CONCLUSIONS: A simple exploratory score incorporating body mass index, transvalvular peak velocity, and LV size was associated with the probability of complete LV functional recovery after TAVI. This pre-procedural tool may facilitate patient counseling, expectation-setting, and identification of patients who may require closer heart failure follow-up after TAVI. It should not be used to determine eligibility for TAVI.

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Journal
Catheterization and Cardiovascular Interventions
Published
2026-10-14
DOI
https://doi.org/10.1002/ccd.70941
Primary Topic
Cardiac Valve Diseases and Treatments
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article
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article

Pre‐Procedural Prediction of Left Ventricular Ejection Fraction Normalization After Transcatheter Aortic Valve Implantation

Hiroshi Ueno, Teruhiko Imamura, Tetsuro Shimura, Kenichi Ishizu et al.
Catheterization and Cardiovascular Interventions
Cardiac Valve Diseases and Treatments
article

Pre‐Procedural Prediction of Left Ventricular Ejection Fraction Normalization After Transcatheter Aortic Valve Implantation

Hiroshi Ueno, Teruhiko Imamura, Tetsuro Shimura, Kenichi Ishizu, Masahiko Asami, Yohei Ohno, Fumiaki Yashima, Takahiro Tokuda, Masanori Yamamoto, Koichiro Kinugawa, Masahiko Noguchi, Kentaro Hayashida, Toshiaki Otsuka, Hiroto Suzuyama, Yasushi Fuku, Gaku Nakazawa, Hidetaka Nishina, Kenji Nishioka, Yuki Hida, Futoshi Yamanaka, Daisuke Hachinohe, Masaki Izumo, Toru Naganuma, Shinichi Shirai, Kazumasa Yamasaki, OCEAN-TAVI Investigators, Yusuke Watanabe
article en

Abstract

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an established therapy for severe aortic stenosis. Among patients with left ventricular (LV) systolic dysfunction, recovery of LV function after TAVI is heterogeneous, and reliable tools for pre-procedural risk stratification and patient counseling remain limited. AIMS: We sought to identify simple pre-procedural predictors of complete LV functional recovery after TAVI and to develop a clinically applicable risk score to support patient counseling and post-procedural management. METHODS: We retrospectively analyzed patients with severe aortic stenosis and baseline LV ejection fraction (LVEF) < 40% enrolled in a large multicenter registry in Japan. The primary outcome was complete LVEF normalization (LVEF > 50%) at 1 year after TAVI. Independent predictors were identified using multivariable logistic regression in a derivation cohort, and an exploratory weighted score was constructed. The score was preliminarily assessed in a separate single-center cohort. RESULTS: The derivation cohort comprised 177 patients (median age 84 years; 44% women), of whom 94 (53%) achieved LVEF normalization. Lower body mass index (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.77-0.95; p = 0.004), higher aortic valve peak velocity (OR 2.45, 95% CI 1.40-4.29; p = 0.002), and smaller LV end-diastolic diameter (OR 0.93, 95% CI 0.88-0.98; p = 0.020) were independently associated with LVEF normalization. The derived score stratified patients into low-, intermediate-, and high-probability groups (15%, 45%, and 71%, respectively; p < 0.001), with consistent discrimination in the validation cohort. CONCLUSIONS: A simple exploratory score incorporating body mass index, transvalvular peak velocity, and LV size was associated with the probability of complete LV functional recovery after TAVI. This pre-procedural tool may facilitate patient counseling, expectation-setting, and identification of patients who may require closer heart failure follow-up after TAVI. It should not be used to determine eligibility for TAVI.

Catheterization and Cardiovascular Interventions
Kansai Medical University (JP), Tokai University (JP), St. Marianna University School of Medicine (JP), Kurashiki Central Hospital (JP), Sapporo Higashi Tokushukai Hospital (JP), New Tokyo Hospital (JP), Saiseikai Kumamoto Hospital (JP), Sapporo Science Center (JP), Tokai University Hospital (JP), Saiseikai Utsunomiya hospital (JP), Mitsui Memorial Hospital (JP), Tsukuba Medical Center Hospital (JP), Toyama University Hospital (JP), Nagoya Heart Center (JP), Shonan Kamakura General Hospital (JP), Nippon Medical School Hospital (JP), Gifu Heart Center (JP), Kokura Memorial Hospital (JP), University of Toyama (JP), Tokyo Bay Urayasu Ichikawa Medical Center (JP), Hiroshima City Hiroshima Citizens Hospital (JP), Nippon Medical School (JP), Teikyo University (JP), Kindai University (JP)
Openalex Percentile: Top 11%
Cardiac Valve Diseases and Treatments
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