Impact of Elevated Preprocedural Left Ventricular Filling Pressure on Prognosis of Mild Paravalvular Regurgitation Following Transcatheter Aortic Valve Replacement

Abstract

ABSTRACTBackgroundParavalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR) is a complication linked to poor outcomes. The prognostic impact of mild PVR, particularly in patients with elevated preprocedural left ventricular (LV) filling pressure, remains uncertain.AimsThis study aimed to assess the influence of elevated preprocedural LV filling pressure on mild PVR prognosis following TAVR.MethodsThis single‐center, retrospective study analyzed consecutive patients with severe aortic stenosis who underwent TAVR, excluding those with moderate or severe PVR. Preprocedural LV filling pressure was evaluated using baseline E/A ratio, and patients were stratified into four groups based on E/A ratio (≤1 or >1) and PVR severity (none/trace or mild). The primary endpoint was cardiovascular death within 5 years.ResultsAmong 904 patients, 466 had E/A ≤ 1 with none/trace PVR, 92 had E/A > 1 with none/trace PVR, 300 had E/A ≤ 1 with mild PVR, and 46 had E/A > 1 with mild PVR. Multivariable analysis identified E/A > 1 with mild PVR as an independent predictor of cardiovascular death (adjusted hazard ratio [HR]: 2.38; 95% confidence interval [CI]: 1.28–4.42; p < 0.01). In contrast, E/A > 1 with none/trace PVR (HR: 1.16, 95% CI: 0.66–2.03) and E/A ≤ 1 with mild PVR (HR: 1.33, 95% CI: 0.89–2.00) were not significant predictors compared to E/A ≤ 1 with none/trace PVR.ConclusionsElevated preprocedural LV filling pressure is independently associated with an increased risk of cardiovascular death in patients with mild PVR following TAVR.