Pre-procedural LVEF below 60% predicted worse outcomes after aortic valve replacement in individuals with severe AS. The AHA Session (2025) report evaluated long-term prognostic implications of LVEF before either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR).
The analysis included 3,369 adults with severe AS enrolled in the CURRENT AS Registry 2, with 1,742 undergoing intervention. SAVR involved 594 individuals and TAVR involved 1,148 individuals. Mean age was 80.8 ± 8.1 years, and 40% were male. Mean baseline LVEF measured 60.7 ± 11.2%. Median follow-up was 2.1 years (interquartile range 1.3–2.9), during which 379 primary composite outcomes occurred, including 270 all-cause deaths and 164 HF hospitalizations.
Receiver operating characteristic analysis identified 59.3% as the optimal LVEF cutoff to predict events. Individuals with LVEF below 60% had higher adjusted risk of the composite outcome (adjusted hazard ratio [HR] 1.50; 95% confidence interval [CI] 1.20–1.88; p<0.001). This association persisted in low-gradient AS (adjusted HR 1.88; 95% CI 1.35–2.62), normal-flow status (adjusted HR 1.95; 95% CI 1.16–3.27), and low-flow status (adjusted HR 1.44; 95% CI 1.11–1.87). High-gradient AS did not show a statistically significant association (adjusted HR 1.23; 95% CI 0.90–1.68).
These findings support LVEF as a strong prognostic marker in severe aortic stenosis, reinforcing guideline recommendations to consider intervention before LVEF declines below 60% in eligible individuals.
