The Prognostic Implications of Change in LVEDP during TAVI.

Background: Elevated left ventricular end diastolic pressure (LVEDP) following transcatheter aortic valve implantation (TAVI) has been identified as a predictor of heart failure and mortality.

Aims: To determine whether change in LVEDP is a more powerful predictor of adverse clinical outcomes than elevated LVEDP post-TAVI.

Methods: Patients who underwent TAVI at two high volume centers between January 2013 and December 2023 were screened for inclusion. LVEDP measurements were taken before and immediately after TAVI. Hospital records were analyzed for mortality and heart failure hospitalization (HFH). Patients were stratified into those whose LVEDP decreased (post-TAVI LVEDP > 5 mmHg lower), didn't change (±5 mmHg) or increased (post-TAVI LVEDP > 5 mmHg higher).

Results: A total of 1073 patients were included. The median follow-up period was 28.9 months with 15.5% followed up for over 5 years. Increase in LVEDP was associated with increased incidence of 5-year mortality (40.3% vs. 28.4% vs. 23.2%; p < 0.001) and HFH (23.3% vs. 10.0% vs. 7.1%; p < 0.001) compared to no change or decrease in LVEDP. On multivariate analysis, increase in LVEDP post-TAVI was an independent predictor of all-cause mortality and HFH. Elevated LVEDP (> 15 mmHg) alone post-TAVI was predictive of HFH but not mortality.

Conclusions: Patients in whom LVEDP increases post-TAVI have a significantly higher incidence of mortality and HFH within 1 month, and this persists for at least 5-years post-procedure. According to our results, the change in LVEDP is a more powerful predictor of adverse clinical outcomes than elevated post-TAVI LVEDP alone.