Key result
Elevated preprocedural LV filling pressure with mild PVR linked to ~138% higher 5-year CV death risk.
Why the study?
The prognostic impact of mild paravalvular regurgitation after TAVR, particularly in patients with elevated preprocedural LV filling pressure, remains uncertain.
Does elevated preprocedural left ventricular filling pressure increase the risk of cardiovascular death in patients with mild paravalvular regurgitation following TAVR?
Cohort (n=904)
No
Does elevated preprocedural left ventricular filling pressure increase the risk of cardiovascular death in patients with mild paravalvular regurgitation following TAVR?
Effect estimate: HR 2.38 (95% CI 1.28-4.42)
p-value: p=<0.01
Elevated preprocedural left ventricular filling pressure (E/A > 1) identifies a high-risk subgroup among patients with mild paravalvular regurgitation after TAVR who have significantly increased cardiovascular mortality.
Elevated preprocedural filling pressure may flag higher CV mortality risk with mild PVR post-TAVR; hypothesis-generating for prospective validation.
BACKGROUND: Paravalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR) is a complication linked to poor outcomes. The prognostic impact of mild PVR, particularly in patients with elevated preprocedural left ventricular (LV) filling pressure, remains uncertain. AIMS: This study aimed to assess the influence of elevated preprocedural LV filling pressure on mild PVR prognosis following TAVR. METHODS: This single-center, retrospective study analyzed consecutive patients with severe aortic stenosis who underwent TAVR, excluding those with moderate or severe PVR. Preprocedural LV filling pressure was evaluated using baseline E/A ratio, and patients were stratified into four groups based on E/A ratio (≤1 or >1) and PVR severity (none/trace or mild). The primary endpoint was cardiovascular death within 5 years. RESULTS: Among 904 patients, 466 had E/A ≤ 1 with none/trace PVR, 92 had E/A > 1 with none/trace PVR, 300 had E/A ≤ 1 with mild PVR, and 46 had E/A > 1 with mild PVR. Multivariable analysis identified E/A > 1 with mild PVR as an independent predictor of cardiovascular death (adjusted hazard ratio [HR]: 2.38; 95% confidence interval [CI]: 1.28-4.42; p < 0.01). In contrast, E/A > 1 with none/trace PVR (HR: 1.16, 95% CI: 0.66-2.03) and E/A ≤ 1 with mild PVR (HR: 1.33, 95% CI: 0.89-2.00) were not significant predictors compared to E/A ≤ 1 with none/trace PVR. CONCLUSIONS: Elevated preprocedural LV filling pressure is independently associated with an increased risk of cardiovascular death in patients with mild PVR following TAVR.
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Kosugi et al. (2025) conducted a cohort in Severe aortic stenosis (n=904). Elevated preprocedural LV filling pressure (E/A > 1) with mild PVR vs. E/A ≤ 1 with none/trace PVR was evaluated on Cardiovascular death within 5 years (HR 2.38, 95% CI 1.28-4.42, p=<0.01). Elevated preprocedural LV filling pressure with mild PVR was independently associated with an increased risk of cardiovascular death at 5 years (HR 2.38; 95% CI 1.28-4.42; p<0.01).
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