Prognostic Value of Tissue Doppler Late Diastolic Velocity (TDI-a’) in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Risk stratification after transcatheter aortic valve implantation (TAVI) in severe aortic stenosis (AS) remains suboptimal. Beyond valvular hemodynamics, a number of standard echocardiographic parameters of function are associated to outcome. Mitral annular late diastolic velocity (TDI-a') is proven to have prognostic value in multiple clinical settings, but its role after TAVI is unresolved. In a single-center retrospective observational study we included adult patients with isolated severe AS (aortic valve area < 1.0 cm²) undergoing TAVI, between December 2013 and August 2025. Pre-procedural transthoracic echocardiography was reviewed offline by blinded investigators to measure TDI-a' velocities. The primary endpoint was all-cause mortality. Logistic regression, Cox proportional hazards models, and ROC analysis were performed. A total of 805 patients (median age 81 years; 44.8% male) were included. During a median follow-up of 36.5 months, 196 deaths (24.3%) occurred. On univariable analysis, left ventricular ejection fraction, E/e' ratio, left atrioventricular coupling index (LACI), and TDI-a' were associated with mortality. In multivariable analysis, average TDI-a' remained the only independent echocardiographic predictor of mortality in both logistic regression (OR 0.88, 95% CI 0.821-0.944; p < 0.001) and Cox analysis (HR 0.934, 95% CI 0.881-0.991; p = 0.023). ROC analysis showed modest discrimination (AUC 0.585), with an optimal cut-off ≤ 8.4 cm/s (sensitivity 65%, specificity 49%). Reduced TDI-a' is independently associated with mortality after TAVI, beyond conventional echocardiographic predictors. Despite modest discrimination, it is a simple prognostic marker that may improve pre-procedural risk stratification and warrants further prospective validation.