Prognostic Utility of Left Ventricular Ejection Fraction in Patients Undergoing Transcatheter Aortic Valve Implantation ― A Systematic Review and Meta-Analysis
Background: Left ventricular ejection fraction (LVEF) is widely used to assess systolic function and to predict cardiovascular outcomes, but its prognostic role in patients undergoing transcatheter aortic valve implantation (TAVI) remains uncertain.Methods and Results: We performed a systematic revi...
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| Published in | Circulation Reports p. CR-25-0126 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
The Japanese Circulation Society
26.08.2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2434-0790 2434-0790 |
| DOI | 10.1253/circrep.CR-25-0126 |
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| Abstract | Background: Left ventricular ejection fraction (LVEF) is widely used to assess systolic function and to predict cardiovascular outcomes, but its prognostic role in patients undergoing transcatheter aortic valve implantation (TAVI) remains uncertain.Methods and Results: 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 for preprocedural LVEF. A total of 92 studies comprising 98 patient cohorts and 75,085 individuals were included. 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. Each 1% decrease in LVEF was associated with an increased risk of adverse events (hazard ratio 1.02, 95% confidence interval: 1.01–1.03), and this association remained significant after adjusting for confounders. Subgroup analyses confirmed the robustness of this association in various settings. In the multivariable meta-regression, studies with lower mean LVEF demonstrated a stronger association between reduced LVEF and adverse outcomes, but this association was attenuated or nonsignificant in cohorts with preserved systolic function. This suggests that the prognostic value of LVEF may depend on the baseline level of ventricular function and is subject to effect modification.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. |
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| AbstractList | Background: Left ventricular ejection fraction (LVEF) is widely used to assess systolic function and to predict cardiovascular outcomes, but its prognostic role in patients undergoing transcatheter aortic valve implantation (TAVI) remains uncertain.Methods and Results: 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 for preprocedural LVEF. A total of 92 studies comprising 98 patient cohorts and 75,085 individuals were included. 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. Each 1% decrease in LVEF was associated with an increased risk of adverse events (hazard ratio 1.02, 95% confidence interval: 1.01–1.03), and this association remained significant after adjusting for confounders. Subgroup analyses confirmed the robustness of this association in various settings. In the multivariable meta-regression, studies with lower mean LVEF demonstrated a stronger association between reduced LVEF and adverse outcomes, but this association was attenuated or nonsignificant in cohorts with preserved systolic function. This suggests that the prognostic value of LVEF may depend on the baseline level of ventricular function and is subject to effect modification.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. |
| ArticleNumber | CR-25-0126 |
| Author | Masaaki Takeuchi Koichi Node Yoshiko Sakamoto Tetsuji Kitano Yosuke Nabeshima |
| Author_xml | – sequence: 1 givenname: Yosuke surname: Nabeshima fullname: Nabeshima, Yosuke – sequence: 2 givenname: Tetsuji surname: Kitano fullname: Kitano, Tetsuji – sequence: 3 givenname: Yoshiko surname: Sakamoto fullname: Sakamoto, Yoshiko – sequence: 4 givenname: Masaaki surname: Takeuchi fullname: Takeuchi, Masaaki – sequence: 5 givenname: Koichi surname: Node fullname: Node, Koichi |
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| Cites_doi | 10.1093/eurjhf/hfp103 10.1056/NEJMoa1202277 10.1007/s12928-024-01074-6 10.1161/CIRCHEARTFAILURE.118.005809 10.1016/j.jcmg.2016.12.028 10.4244/EIJ-D-19-00399 10.3389/fcvm.2022.965440 10.1007/s12928-023-00924-z 10.1007/s12928-025-01094-w 10.1016/j.carrev.2024.03.005 10.1371/journal.pone.0027556 10.1002/14651858.CD013319.pub2 10.1136/heartjnl-2021-320364 10.1016/j.amjcard.2021.04.037 10.1016/j.jcmg.2017.11.017 10.1016/j.jacasi.2021.10.006 10.3390/jcm12237429 10.1056/NEJMoa2400685 10.1253/circrep.CR-23-0063 10.1016/j.jcmg.2023.01.005 10.1136/bmj.n71 10.1007/s00380-022-02211-y 10.1007/s12928-024-01043-z 10.24875/RECIC.M24000465 10.1007/s12928-023-00971-6 |
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Blankenberg S, Seiffert M, Vonthein R, Baumgartner H, Bleiziffer S, Borger MA, et al. Transcatheter or surgical treatment of aortic-valve stenosis. N Engl J Med 2024; 390: 1572–1583, doi:10.1056/NEJMoa2400685. 25. Martínez Gómez E, Solar X, Faria D, Nombela Franco L, Jiménez Quevedo P, Tirado G, et al. Prognosis of patients with supranormal ejection fraction undergoing percutaneous aortic valve replacement. REC Interv Cardiol 2024; 6: 271–277, doi:10.24875/RECIC.M24000465. 17. Schewel J, Schluter M, Schmidt T, Kuck KH, Frerker C, Schewel D. Early haemodynamic changes and long-term outcome of patients with severe low-gradient aortic stenosis after transcatheter aortic valve replacement. EuroIntervention 2020; 15: 1181–1189, doi:10.4244/EIJ-D-19-00399. 24. Imamura T, Hida Y, Ueno H, Kinugawa K, Yashima F, Tada N, et al. Clinical implication of supra-normal left ventricular ejection fraction in patients undergoing transcatheter aortic valve replacement. 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Transcatheter aortic valve replacement in Asia: Present status and future perspectives. JACC Asia 2021; 1: 279–293, doi:10.1016/j.jacasi.2021.10.006. 3. Kolkailah AA, Doukky R, Pelletier MP, Volgman AS, Kaneko T, Nabhan AF. Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk. Cochrane Database Syst Rev 2019; 12: CD013319, doi:10.1002/14651858.CD013319.pub2. 5. Kobayashi Y, Izumo M, Okuyama K, Uenomachi N, Shoji T, Kai T, et al. Feasibility of transcatheter aortic valve implantation in patients with very severe aortic stenosis. Circ Rep 2023; 5: 358–364, doi:10.1253/circrep.CR-23-0063. 22 23 24 25 10 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 20 21 |
| References_xml | – reference: 14. Gilchrist IC Jr, Kort S, Wang TY, Tannous H, Pyo R, Gracia E, et al. Impact of left ventricular ejection fraction and aortic valve gradient on mortality following transcatheter aortic valve intervention. Cardiovasc Revasc Med 2024; 65: 32–36, doi:10.1016/j.carrev.2024.03.005. – reference: 15. Kang DY, Ahn JM, Kim JB, Yeung A, Nishi T, Fearon W, et al. Inter-racial differences in patients undergoing transcatheter aortic valve implantation. Heart 2022; 108: 1562–1570, doi:10.1136/heartjnl-2021-320364. – reference: 23. Lee CH, Inohara T, Hayashida K, Park DW. Transcatheter aortic valve replacement in Asia: Present status and future perspectives. JACC Asia 2021; 1: 279–293, doi:10.1016/j.jacasi.2021.10.006. – reference: 9. Pfenniger A, Stolte T, Reichl JJ, Leibundgut G, Wagener M, Kaiser C, et al. Comparison of invasive and non-invasive gradients before and after TAVI and their implications on clinical outcomes. Cardiovasc Interv Ther 2025; 40: 362–377. – reference: 10. Imamura T, Izumida T, Onoda H, Tanaka S, Ushijima R, Sobajima M, et al. Trajectory of pulmonary congestion during TAVR. Cardiovasc Interv Ther 2024; 39: 183–190, doi:10.1007/s12928-023-00971-6. – reference: 4. Makkar RR, Fontana GP, Jilaihawi H, Kapadia S, Pichard AD, Douglas PS, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med 2012; 366: 1696–1704, doi:10.1056/NEJMoa1202277. – reference: 20. Stens NA, van Iersel O, Rooijakkers MJP, van Wely MH, Nijveldt R, Bakker EA, et al. Prognostic value of preprocedural lv global longitudinal strain for post-TAVR-related morbidity and mortality: A meta-analysis. JACC Cardiovasc Imaging 2023; 16: 332–341, doi:10.1016/j.jcmg.2023.01.005. – reference: 13. Furer A, Chen S, Redfors B, Elmariah S, Pibarot P, Herrmann HC, et al. Effect of baseline left ventricular ejection fraction on 2-year outcomes after transcatheter aortic valve replacement: Analysis of the PARTNER 2 trials. Circ Heart Fail 2019; 12: e005809, doi:10.1161/CIRCHEARTFAILURE.118.005809. – reference: 16. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021; 372: n71, doi:10.1136/bmj.n71. – reference: 25. Martínez Gómez E, Solar X, Faria D, Nombela Franco L, Jiménez Quevedo P, Tirado G, et al. Prognosis of patients with supranormal ejection fraction undergoing percutaneous aortic valve replacement. REC Interv Cardiol 2024; 6: 271–277, doi:10.24875/RECIC.M24000465. – reference: 19. Sakaguchi E, Yamada A, Naruse H, Hattori H, Nishimura H, Kawai H, et al. Long-term prognostic value of changes in left ventricular global longitudinal strain in patients with heart failure with preserved ejection fraction. Heart Vessels 2023; 38: 645–652, doi:10.1007/s00380-022-02211-y. – reference: 5. Kobayashi Y, Izumo M, Okuyama K, Uenomachi N, Shoji T, Kai T, et al. Feasibility of transcatheter aortic valve implantation in patients with very severe aortic stenosis. Circ Rep 2023; 5: 358–364, doi:10.1253/circrep.CR-23-0063. – reference: 24. Imamura T, Hida Y, Ueno H, Kinugawa K, Yashima F, Tada N, et al. Clinical implication of supra-normal left ventricular ejection fraction in patients undergoing transcatheter aortic valve replacement. J Clin Med 2023; 12: 7429, doi:10.3390/jcm12237429. – reference: 1. Somaratne JB, Berry C, McMurray JJ, Poppe KK, Doughty RN, Whalley GA. The prognostic significance of heart failure with preserved left ventricular ejection fraction: A literature-based meta-analysis. Eur J Heart Fail 2009; 11: 855–862, doi:10.1093/eurjhf/hfp103. – reference: 12. Jeong YJ, Ahn JM, Kang DY, Park H, Ko E, Kim HJ, et al. Incidence, Predictors, and prognostic impact of immediate improvement in left ventricular systolic function after transcatheter aortic valve implantation. Am J Cardiol 2021; 152: 99–105, doi:10.1016/j.amjcard.2021.04.037. – reference: 3. Kolkailah AA, Doukky R, Pelletier MP, Volgman AS, Kaneko T, Nabhan AF. Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk. Cochrane Database Syst Rev 2019; 12: CD013319, doi:10.1002/14651858.CD013319.pub2. – reference: 8. Abe T, Nagai T, Yuasa A, Tokuda Y, Ishizaka S, Takenaka S, et al. Usefulness of frailty assessment using the revised Japanese version of the Cardiovascular Health Study on the prediction of clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Cardiovasc Interv Ther 2025; 40: 144–151, doi:10.1007/s12928-024-01043-z. – reference: 11. Pilgrim T, Wenaweser P, Meuli F, Huber C, Stortecky S, Seiler C, et al. Clinical outcome of high-risk patients with severe aortic stenosis and reduced left ventricular ejection fraction undergoing medical treatment or TAVI. PLoS One 2011; 6: e27556, doi:10.1371/journal.pone.0027556. – reference: 2. Blankenberg S, Seiffert M, Vonthein R, Baumgartner H, Bleiziffer S, Borger MA, et al. Transcatheter or surgical treatment of aortic-valve stenosis. N Engl J Med 2024; 390: 1572–1583, doi:10.1056/NEJMoa2400685. – reference: 21. Xiao Y, Bi W, Qiao W, Wang X, Li Y, Ren W. Prognostic value of ventricular longitudinal strain in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9: 965440, doi:10.3389/fcvm.2022.965440. – reference: 7. Miyahara D, Izumo M, Sato Y, Shoji T, Yamaga M, Sekiguchi M, et al. Calcium channel blocker use and outcomes following transcatheter aortic valve intervention for aortic stenosis. Cardiovasc Interv Ther 2025; 40: 352–361, doi:10.1007/s12928-025-01094-w. – reference: 18. Potter E, Marwick TH. Assessment of left ventricular function by echocardiography: The case for routinely adding global longitudinal strain to ejection fraction. JACC Cardiovasc Imaging 2018; 11: 260–274, doi:10.1016/j.jcmg.2017.11.017. – reference: 6. Matsushita K, Morel O, Ohlmann P. Contemporary issues and lifetime management in patients underwent transcatheter aortic valve replacement. Cardiovasc Interv Ther 2023; 38: 275–286, doi:10.1007/s12928-023-00924-z. – reference: 17. Schewel J, Schluter M, Schmidt T, Kuck KH, Frerker C, Schewel D. Early haemodynamic changes and long-term outcome of patients with severe low-gradient aortic stenosis after transcatheter aortic valve replacement. EuroIntervention 2020; 15: 1181–1189, doi:10.4244/EIJ-D-19-00399. – reference: 22. Kataoka A, Watanabe Y, Kozuma K, Nara Y, Nagura F, Kawashima H, et al. Prognostic impact of low-flow severe aortic stenosis in small-body patients undergoing TAVR: The OCEAN-TAVI registry. JACC Cardiovasc Imaging 2018; 11: 659–669, doi:10.1016/j.jcmg.2016.12.028. – ident: 1 doi: 10.1093/eurjhf/hfp103 – ident: 4 doi: 10.1056/NEJMoa1202277 – ident: 9 doi: 10.1007/s12928-024-01074-6 – ident: 13 doi: 10.1161/CIRCHEARTFAILURE.118.005809 – ident: 22 doi: 10.1016/j.jcmg.2016.12.028 – ident: 17 doi: 10.4244/EIJ-D-19-00399 – ident: 21 doi: 10.3389/fcvm.2022.965440 – ident: 6 doi: 10.1007/s12928-023-00924-z – ident: 7 doi: 10.1007/s12928-025-01094-w – ident: 14 doi: 10.1016/j.carrev.2024.03.005 – ident: 11 doi: 10.1371/journal.pone.0027556 – ident: 3 doi: 10.1002/14651858.CD013319.pub2 – ident: 15 doi: 10.1136/heartjnl-2021-320364 – ident: 12 doi: 10.1016/j.amjcard.2021.04.037 – ident: 18 doi: 10.1016/j.jcmg.2017.11.017 – ident: 23 doi: 10.1016/j.jacasi.2021.10.006 – ident: 24 doi: 10.3390/jcm12237429 – ident: 2 doi: 10.1056/NEJMoa2400685 – ident: 5 doi: 10.1253/circrep.CR-23-0063 – ident: 20 doi: 10.1016/j.jcmg.2023.01.005 – ident: 16 doi: 10.1136/bmj.n71 – ident: 19 doi: 10.1007/s00380-022-02211-y – ident: 8 doi: 10.1007/s12928-024-01043-z – ident: 25 doi: 10.24875/RECIC.M24000465 – ident: 10 doi: 10.1007/s12928-023-00971-6 |
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| SubjectTerms | Aortic stenosis Left ventricular ejection fraction Prognosis Transcatheter aortic valve implantation |
| Title | Prognostic Utility of Left Ventricular Ejection Fraction in Patients Undergoing Transcatheter Aortic Valve Implantation ― A Systematic Review and Meta-Analysis |
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| ispartofPNX | Circulation Reports, 2025/08/26, pp.CR-25-0126 |
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| linkProvider | National Library of Medicine |
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