Transvalvular Flow Rate is Associated With Mortality Rate and Lifetime Loss in Aortic Valve Stenosis: A Meta-Analysis of Reconstructed Time-to-Event Data

Low-flow states are associated with adverse outcomes in AS, but the prognostic value of Transvalvular Flow Rate (TFR) has not been consistently established across studies. This study is a systematic review and meta-analysis of reconstructed time-to-event data was performed in accordance with PRISMA. PubMed/MEDLINE, EMBASE, and Cochrane Library were searched for studies (published by November 14, 2025) comparing low versus normal TFR in AS. Data were collected from Kaplan-Meier curves. The primary endpoint was all-cause mortality. Survival was assessed using pooled Kaplan-Meier curves, Cox regression, flexible parametric survival models, and restricted mean survival time (RMST) analysis. A total of nine studies including 6,494 patients were analyzed; 2,575 (39.7%) had low TFR. At 8 years of follow-up, estimated survival was 34.1% (95% CI: 24.7%-47.0%) in the low-TFR group and 63.0% (95% CI: 58.9%-67.4%) in the normal-TFR group. Low TFR was associated with higher all-cause mortality (HR 1.59; 95%CI 1.45-1.74; P<0.001). We observed a progressively greater hazard over time, with the HR approaching 1.9 by 8 years. At 8 years, RMST in the normal-TFR group was 7.37 years (95% CI: 7.21-7.53 years) versus 5.07 years (95%CI 4.91-5.23 years) in the low-TFR group, representing a lifetime loss of 2.3 years in the low TFR group (ΔRMST -2.30 years; 95%CI -2.53 to -2.07 years; P<0.001). In patients with AS, low TFR is associated with significantly higher mortality and lifetime loss. These findings support TFR as a clinically meaningful marker for risk stratification in AS.