Incidence and management of heart failure phenotypes in patients undergoing transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) has become the standard treatment for severe aortic stenosis (AS) in elderly patients or those at elevated risk for surgical aortic valve replacement.1 Heart failure (HF) is highly prevalent in this population and frequently coexists with AS across the entire spectrum of left ventricular ejection fraction (LVEF).1,2 While TAVI markedly improves symptoms as well as morbidity and mortality in the majority of patients, some continue to experience HF symptoms after the procedure.3 Repeat HF hospitalizations after TAVI are associated with worse prognosis.4 Whereas HF with reduced ejection fraction (HFrEF) is commonly recognized in patients with AS, HF with mildly reduced (HFmrEF) and, most importantly, preserved ejection fraction (HFpEF) often remain underdiagnosed in this population. Guideline-directed medical therapy (GDMT) has shown to improve prognosis and is recommended for patients with HF according to the recent European Society of Cardiology (ESC) guidelines.1 Recently, the Dapagliflozin after TAVI (DapaTAVI) trial demonstrated that treatment with the sodium-glucose linked co-transporter 2 inhibitor (SGLT2i) dapagliflozin significantly reduced the incidence of HF events in patients with an established indication for SGLT2i undergoing TAVI, providing evidence to support its integration as part of GDMT in this setting.5 These findings underscore that correction of the valvular lesion alone may not be sufficient, and that targeted pharmacological therapy plays a key role in improving prognosis. This study aimed to assess the prevalence of HF phenotypes and implementation of GDMT in patients undergoing TAVI as real-world data remain limited.