Each 1% decrease in preprocedural LVEF was independently associated with a higher risk of adverse clinical outcomes after TAVI (HR 1.03; 95% CI 1.01-1.05; p=0.009).
Meta-Analysis (n=75,085)
Yes
Does reduced preprocedural LVEF independently predict worse clinical outcomes in patients undergoing TAVI?
Reduced preprocedural LVEF is an independent predictor of worse clinical outcomes, including all-cause death and MACE, in patients undergoing TAVI.
Hazard Ratio: 1.03 (95% CI 1.01–1.05)
p-value: p=0.009
Abstract Background Left ventricular ejection fraction (LVEF) is widely used to assess systolic function and predict cardiovascular outcomes, but its prognostic role in patients undergoing transcatheter aortic valve implantation (TAVI) remains uncertain. Purpose To evaluate whether preprocedural LVEF independently predicts clinical outcomes after TAVI through a large-scale meta-analysis. Methods We performed a systematic review and meta-analysis of studies published from 2001 to 2024 that evaluated the association between preprocedural LVEF and post-TAVI outcomes. Eligible studies were identified via PubMed and Scopus and included those reporting hazard ratios (HR) for preprocedural LVEF. Random-effects models were used for univariable and multivariable analyses. Subgroup and meta-regression analyses assessed effect modifiers, including ethnicity, LVEF classification, endpoints, and study design. Results A total of 92 studies encompassing 98 independent patient cohorts and 75,085 individuals were included in the meta-analysis. In the univariable analysis, each 1% decrease in baseline LVEF was significantly associated with a higher risk of adverse clinical outcomes, with a pooled HR of 1.02 (95% confidence interval CI: 1.01–1.03; p 0.001). This effect persisted in multivariable-adjusted analyses, with an HR of 1.03 (95% CI: 1.01–1.05; p = 0.009), confirming the independent prognostic value of LVEF after adjusting for other clinical and echocardiographic covariates. (Abstract Picture 1) Subgroup analyses demonstrated the robustness of this association across diverse populations and settings, including Asian, European, and North American cohorts, and across preserved and mixed LVEF strata. The association remained statistically significant for both all-cause death and major adverse cardiovascular events (MACEs). Further, a meta-regression analysis indicated a dose-response-like relationship, in which the prognostic impact of LVEF was more pronounced in cohorts with lower mean baseline LVEF values (p = 0.025 in multivariable models), suggesting that LVEF’s predictive value may be particularly critical in patients with more advanced myocardial dysfunction. Conclusions Reduced preprocedural LVEF is independently associated with worse prognosis after TAVI. These results highlight the continued importance of LVEF in risk stratification and clinical decision-making in TAVI candidates.Forest Plot (multivariable analysis)
Nabeshima et al. (Thu,) conducted a meta-analysis in Patients undergoing TAVI (n=75,085). Preprocedural LVEF (per 1% decrease) vs. Higher baseline LVEF was evaluated on Adverse clinical outcomes (including all-cause death and MACEs) (HR 1.03, 95% CI 1.01-1.05, p=0.009). Each 1% decrease in preprocedural LVEF was independently associated with a higher risk of adverse clinical outcomes after TAVI (HR 1.03; 95% CI 1.01-1.05; p=0.009).