Clinical Impact of the ‘Delta-Aortic Valve Gradient’, the Reduction in the Mean Aortic Valve Pressure Gradient After Transcatheter Aortic Valve Implantation, on Left Ventricular Ejection Fraction Improvement and Long-Term Mortality in Patients With Severe Aortic Stenosis and Left Ventricular Dysfunction

Q: What are the key findings of this study?

In patients with severe aortic stenosis and reduced left ventricular ejection fraction, a higher delta-aortic valve gradient after TAVI independently predicted 1-year LVEF improvement (OR 1.04).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Severe aortic stenosis with left ventricular dysfunction (n=121). Intervention: Delta-aortic valve gradient (delta-AVG) vs. Lower delta-AVG. Primary outcome: 1-year LVEF improvement (≥10% increase from baseline) (OR 1.04, 95% CI 1.01-1.07, p=0.002).

Q: What does this research mean for the field?

The reduction in mean aortic valve pressure gradient (Delta-AVG) after transcatheter aortic valve implantation independently predicts 1-year improvement in left ventricular ejection fraction in patients with severe aortic stenosis and left ventricular dysfunction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the clinical impact of delta-aortic valve gradient, the reduction in mean aortic valve pressure gradient after transcatheter aortic valve implantation, on 1-year left ventricular ejection fraction improvement and long-term mortality in patients with severe aortic stenosis and left ventricular dysfunction.

Naoto Murakami; Kenichi ISHIZU; Masaomi Hayashi; S Shirai

doi:10.1253/circrep.cr-25-0227

February 26, 2026Circulation ReportsOpen Access

Clinical Impact of the ‘Delta-Aortic Valve Gradient’, the Reduction in the Mean Aortic Valve Pressure Gradient After Transcatheter Aortic Valve Implantation, on Left Ventricular Ejection Fraction Improvement and Long-Term Mortality in Patients With Severe Aortic Stenosis and Left Ventricular Dysfunction

View Full Paper

Ask AI

Bookmark

Share

Key result

Greater post-TAVI aortic valve gradient reduction is linked to ~4% higher odds of 1-year LVEF improvement.

OR 1.04
95% CI 1.01-1.07
P=0.002
n=121

Figures

Why the study?

The relationship between the reduction in aortic valve pressure gradient after TAVI and improvements in LVEF or long-term survival remains unclear.

Does a greater reduction in mean aortic valve pressure gradient (delta-AVG) after TAVI predict 1-year LVEF improvement and long-term survival in patients with severe aortic stenosis and LVEF <50%?

Key Points

To investigate the clinical impact of delta-aortic valve gradient, the reduction in mean aortic valve pressure gradient after transcatheter aortic valve implantation, on 1-year left ventricular ejection fraction improvement and long-term mortality in patients with severe aortic stenosis and left ventricular dysfunction.
Retrospectively analyzed 121 patients with aortic stenosis and left ventricular ejection fraction <50% who underwent transcatheter aortic valve implantation at Kokura Memorial Hospital.
Evaluated mean aortic valve gradient via transthoracic echocardiography before and after the procedure to calculate delta-aortic valve gradient.
Assessed left ventricular ejection fraction improvement (defined as a ≥10% increase from baseline at 1 year) in 82 patients and tracked cardiac mortality over a mean follow-up of 1,042.6±577.5 days.
Left ventricular ejection fraction improvement occurred in 37 of 82 patients (45.1%) at 1 year, with higher delta-aortic valve gradient independently predicting improvement (odds ratio 1.04; 95% CI 1.01–1.07; P=0.002) at an optimal cut-off of 20.5 mmHg (sensitivity 48.9%; specificity 89.2%; area under curve 0.723; P=0.002).
During long-term follow-up, 5 cardiac deaths occurred, and a low delta-aortic valve gradient was an independent predictor of cardiac death (hazard ratio 0.91; 95% CI 0.7–0.99; P=0.023).
A greater delta-aortic valve gradient significantly correlated with a larger increase in delta-stroke volume from post-procedure to 1 year (r=0.255; P=0.021).

Study Design

Type

Observational (n=121)

Multicenter

No

Structured PICO

Does a greater reduction in mean aortic valve pressure gradient (delta-AVG) after TAVI predict 1-year LVEF improvement and long-term survival in patients with severe aortic stenosis and LVEF <50%?

P

Population

121 patients with severe aortic stenosis and left ventricular ejection fraction <50% who underwent transcatheter aortic valve implantation, followed for a mean of 1,042 days.

E

Exposure

Transcatheter aortic valve implantation (TAVI) with evaluation of the reduction in mean aortic valve pressure gradient (delta-AVG)

O

Outcome

1-year LVEF improvement, defined as an increase of ≥10% in LVEF from baseline to 1 year after TAVIsurrogate

Main Result

Odds Ratio: 1.04 (95% CI 1.01–1.07)

p-value: p=0.002

Limitations

Non-randomized observational study with retrospective analysis, introducing potential selection and treatment biases
Lack of a core laboratory for echocardiography, which may have led to inter-observer variability
Only LVEF was evaluated as an indicator of LV contractility, potentially missing subtle improvements detectable by strain echocardiography or CMR
Limited follow-up data with some severe cases with fatal outcomes excluded from long-term analysis
Non-randomized observational study including a retrospective analysis, so potential biases in patient selection and treatment strategies cannot be excluded
No core laboratory for TTE, so inter-observer variability in echocardiographic evaluation may have influenced the results

Implication

In patients with severe aortic stenosis and reduced LVEF undergoing TAVI, a greater reduction in the aortic valve pressure gradient (delta-AVG) independently predicts 1-year LVEF improvement and better long-term survival.

Abstract

Background: The relationship between the reduction in aortic valve pressure gradient (AVG) after transcatheter aortic valve implantation (TAVI) and improvements in left ventricular ejection fraction (LVEF) or long-term survival remains unclear. Methods and Results: We retrospectively analyzed 121 patients with aortic stenosis (AS) and LVEF <50% who underwent TAVI. Transthoracic echocardiography (TTE) was performed before and after TAVI, and the difference in mean AVG was defined as delta-AVG. LVEF improvement was defined as a ≥10% increase from baseline at 1 year. Among 82 patients with 1-year TTE evaluation, LVEF improvement was observed in 37 (45.1%) patients. A higher delta-AVG was identified as an independent predictor of LVEF improvement (odds ratio 1.04; 95% confidence interval [CI] 1.01-1.07; P=0.002), and receiver operating characteristic analysis indicated the optimal cut-off was 20.5 mmHg (sensitivity 48.9%; specificity 89.2%; area under curve 0.723; P=0.002). During a mean follow up of 1,042.6±577.5 days, 5 cardiac deaths occurred. Cox proportional hazards analysis revealed that a low delta-AVG was identified as an independent predictor of cardiac death (hazard ratio 0.91; 95% CI 0.7-0.99; P=0.023). Additionally, a greater delta-AVG was significantly associated with a larger increase in delta-stroke volume between post-TAVI to 1 year (r=0.255; P=0.021). Conclusions: In patients with severe AS and reduced LVEF, delta-AVG could be a novel predictor of 1-year LVEF improvement and long-term survival after TAVI.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Murakami et al. (2026) conducted an observational in Severe aortic stenosis with left ventricular dysfunction (n=121). Delta-aortic valve gradient (delta-AVG) vs. Lower delta-AVG was evaluated on 1-year LVEF improvement (≥10% increase from baseline) (OR 1.04, 95% CI 1.01-1.07, p=0.002). In patients with severe aortic stenosis and reduced left ventricular ejection fraction, a higher delta-aortic valve gradient after TAVI independently predicted 1-year LVEF improvement (OR 1.04).

synapsesocial.com/papers/69a287010a974eb0d3c0262a https://doi.org/10.1253/circrep.cr-25-0227

View Full Paper

Ask AI

Bookmark

Share

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading