Prognostic Value of the HFpEF-ABA Score Among Patients Undergoing Transcatheter Aortic Valve Implantation

BACKGROUND Aortic stenosis (AS) and heart failure with preserved ejection fraction (HFpEF) share common pathophysiologic features and comorbidities and often co-exist, but their combined prognostic impact is unclear. We aimed to assess HFpEF probability among patients with AS undergoing transcatheter aortic valve implantation (TAVI) and evaluate its impact on clinical presentation and outcomes. METHOD In this retrospective cohort study, consecutive patients with severe AS and preserved left ventricular EF undergoing TAVI were stratified into low (<25%), intermediate (25%-74%) and high (≥75%) HFpEF probability groups using the HFpEF-ABA score (incorporating age, body mass index, and atrial fibrillation history). Demographics, echocardiographic parameters, functional status, quality of life, and outcomes were compared. RESULTS Among 2,175 patients (median age 82 years; interquartile range 78-86; 44.7% female), 2 (0.1%) had low, 735 (36.1%) intermediate, and 1,388 (63.8%) high HFpEF probability. Patients with high HFpEF probability were older, had more typical HFpEF-related comorbidities, and exhibited poorer quality of life, more severe dyspnoea, and increased cardiac remodelling (higher left ventricular mass and dimensions, pulmonary hypertension, and mitral regurgitation), despite less severe traditional markers of AS. Post-TAVI, both groups had similar improvements in valve haemodynamics, and there was no significant difference in the primary composite end point of 12-month HF hospitalisation or mortality between the high and low-intermediate probability groups (odds ratio 1.32; 95% confidence interval 0.92-1.88; p=0.13). However, high HFpEF probability was associated with increased permanent pacemaker implantation, worse post-TAVI functional status, lower quality of life, and a greater risk of 12-month HF hospitalisation. CONCLUSIONS The HFpEF-ABA score identifies a high-risk phenotype of AS patients undergoing TAVI, characterised by adverse cardiac remodelling, poorer functional status, and increased post-TAVI complications. Further studies are required to determine whether HFpEF-specific therapies would benefit this population.