Key result
TAVR-PRO risk score predicts poor 6-month functional outcomes after TAVR with ~0.86 AUC.
Why the study?
Despite the success of TAVR for severe aortic stenosis in older adults, a subset experience poor functional recovery, necessitating a predictive risk score for poor 6-month outcomes.
Does the TAVR-PRO risk score predict poor functional outcome and mortality in elderly patients undergoing transcatheter aortic valve replacement?
Cohort (n=204)
No
Does the TAVR-PRO risk score predict poor functional outcome and mortality in elderly patients undergoing transcatheter aortic valve replacement?
Effect estimate: AUC 0.86 (95% CI 0.77-0.94)
Absolute Event Rate: 81.8% vs 14.8%
p-value: p=<0.001
A simple 5-variable risk score (TAVR-PRO) effectively predicts which elderly patients with severe aortic stenosis are likely to experience poor functional recovery and increased mortality 6 months after TAVR.
May aid risk stratification for poor functional recovery in elderly TAVR patients; leaves open prospective validation before clinical adoption.
Purpose: Despite the success of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS), a subset of older adults experience poor functional recovery. We aimed to develop and validate a pragmatic clinical risk score to predict poor 6-month functional outcomes in this population. Methods: We conducted a retrospective cohort study of 204 elderly patients (≥ 65 years, 106 males and 98 females) with severe AS who underwent TAVR at our center between March 2021 and March 2024. The primary endpoint was poor functional outcome at 6 months, defined as a composite of failure to improve left ventricular ejection fraction (LVEF) by > 10% and failure to increase 6-minute walk test (6MWT) distance by > 50 meters. Patients were randomly split into a training cohort (n=143) and a validation cohort (n=61). LASSO regression was used in the training cohort to identify predictors and construct the TAVR-PRO (Transcatheter Aortic Valve Replacement - Poor Recovery Outcome) risk score. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and calibration plots. A secondary endpoint of 1-year all-cause mortality was analyzed using Kaplan-Meier curves. Results: Five independent predictors were incorporated into the TAVR-PRO score: advanced age (≥ 80 years), Clinical Frailty Scale (CFS) > 4, NT-proBNP > 3000 pg/mL, coronary artery disease, and chronic kidney disease (eGFR < 45 mL/min/1.73m 2 ). The score demonstrated good discrimination in both the training (AUC = 0.88) and validation cohorts (AUC = 0.86), with excellent calibration. Higher scores were significantly associated with poor functional outcome and increased 1-year all-cause mortality (P < 0.001). Conclusion: The TAVR-PRO score, based on five readily available variables, is a simple and effective tool for predicting poor functional outcomes and mortality after TAVR in older adults. This score can aid in shared decision-making, patient counseling, and identifying high-risk individuals for targeted interventions.
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Zhang et al. (2026) conducted a cohort in Severe symptomatic aortic stenosis (n=204). TAVR-PRO risk score vs. Low TAVR-PRO risk score was evaluated on Poor functional outcome at 6 months (composite of failure to improve LVEF by >10% and 6MWT distance by >50m) (AUC 0.86, 95% CI 0.77-0.94, p=<0.001). The TAVR-PRO risk score effectively predicted poor 6-month functional outcomes after transcatheter aortic valve replacement, demonstrating an AUC of 0.86 in the validation cohort.
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