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

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BACKGROUND: Paravalvular 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. AIMS: This study aimed to assess the influence of elevated preprocedural LV filling pressure on mild PVR prognosis following TAVR. METHODS: This 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. RESULTS: Among 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. CONCLUSIONS: Elevated preprocedural LV filling pressure is independently associated with an increased risk of cardiovascular death in patients with mild PVR following TAVR.

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