Predictors of cardiovascular mortality and heart failure hospitalizations in patients with paradoxical low-flow, low-gradient aortic stenosis treated with TAVI

Abstract Introduction Patients with paradoxical low-flow, low-gradient aortic stenosis (pLF/LG AS) and preserved left ventricular ejection fraction (LVEF) present with specific physiological and hemodynamic characteristics that may be associated with adverse clinical outcomes during follow-up. Our objective was to identify the clinical and echocardiographic characteristics associated with the occurrence of adverse clinical events in patients with pLF/LG AS after transcatheter aortic valve implantation (TAVI). Methods Retrospective analysis of a prospective cohort of 131 patients with pLF/LG AS who underwent TAVI at a tertiary care hospital between 2008 and 2023. The association between baseline clinical and echocardiographic characteristics and the incidence of the composite endpoint of cardiovascular mortality (CV) or heart failure (HF) hospitalizations was assessed by means of Cox regression analysis. Results The mean age of the patients included in our cohort was 82.6 (5.5) years, and 51.9% were women. Arterial hypertension was present in 84% of patients, and 40% were diabetic. Mean stroke volume index (SVi) was 27.8 (5.3) ml/m², mean aortic valve area was 0.78 (0.3) cm², and mean aortic pressure gradient was 30.5 (±7) mmHg. During a median follow-up period of 31 months, 27 patients (20.6%) experienced the composite outcome of CV death or HF hospitalization. Variables statistically associated with the composite endpoint in the univariable analysis included history of atrial fibrillation, STS score, left atrial volume index, SVi, E/e’ ratio, and right ventricular-pulmonary artery coupling (Table). The three variables independently associated with outcomes in the multivariable analysis were SVi, E/e’ ratio, and right ventricular-pulmonary artery coupling. A predictive model incorporating these variables yielded a Harrell’s C-index of 0.834. Conclusion In patients with pLF/LG AS, echocardiographic parameters that were independently associated with the incidence of clinical events were SVi, E/e’ ratio, and particularly, right ventricular-pulmonary artery coupling. These findings highlight the relevance of right ventricular function in the prognosis of patients with pLF/LG AS.Cox regression analysis