Global myocardial performance and long-term mortality after TAVI: prognostic value of the TEI index

Background Transcatheter aortic valve implantation (TAVI) effectively relieves valvular obstruction in patients with severe aortic stenosis (AS); however, long-term outcomes remain heterogeneous. While procedural success is high, many patients continue to experience an excess risk of death, suggesting that factors beyond the valve itself may determine prognosis. Global myocardial performance, reflecting integrated systolic and diastolic function, may capture residual heart failure biology after TAVI. Methods and Results In this retrospective single-center cohort study, consecutive patients undergoing transfemoral TAVI between 2016 and 2022 were screened. Patients with permanent atrial fibrillation (AF) or inadequate echocardiographic data were excluded. Global myocardial performance was assessed pre-procedurally using the myocardial performance (TEI) index. The primary endpoint was all-cause mortality at 3 years. A total of 412 patients (mean age 82.1 ± 5.1 years; 47.1% male) were included. Higher TEI index values were associated with increased 3-year mortality in a graded manner. In multivariable Cox regression, each 0.1-unit increase in the TEI index was independently associated with a higher risk of death (HR 1.49, 95% CI 1.19–1.87; p < 0.001). A pre-specified TEI index threshold of 0.45 effectively stratified patients into distinct long-term risk groups, with early and persistent separation of Kaplan–Meier survival curves. The TEI index provided incremental prognostic value beyond established clinical and echocardiographic parameters and demonstrated consistent associations across clinically relevant subgroups. Restricted cubic spline analyses supported an approximately linear relationship between the TEI index and mortality risk. Conclusions In patients undergoing TAVI, impaired global myocardial performance assessed before intervention is an independent predictor of long-term survival. The TEI index provides incremental prognostic value beyond established parameters, highlighting myocardial dysfunction as an important determinant of outcomes beyond valvular obstruction.