Journal of the American Heart Association· 2026Q1
Impact of Balloon‐Expandable Valve Asymmetry on Heart Failure Post Transcatheter Aortic Valve Replacement
- 1citations
- Q1SCImago
- 2026year
Short summary
A valve asymmetry index >7.48% measured by fluoroscopy post-TAVR is independently associated with a 69% increased risk of late heart failure hospitalization (beyond 30 days).
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Key points
- Valve asymmetry index >7.48% was identified as a threshold for increased risk of heart failure hospitalization post-TAVR.
- Patients with asymmetry index >7.48% had a 23.6% incidence of HF hospitalization compared to 15.8% in those below the threshold.
- Marked valve asymmetry (>7.48%) was independently associated with a 1.69-fold increased risk of late HF hospitalization (beyond 30 days).
- This association persisted despite comparable rates of impaired valve performance at discharge between groups.
AI-generated from the title and abstract; the full text is not read.
Abstract
Background Fluoroscopic assessment enables immediate evaluation of transcatheter heart valve expansion during transcatheter aortic valve replacement (TAVR). Whether fluoroscopic asymmetric expansion of balloon‐expandable valves is associated with post‐TAVR heart failure (HF) remains uncertain. Methods Among 607 consecutive patients undergoing balloon‐expandable valve‐TAVR in a prospective registry, 589 were analyzed. Valve asymmetry was quantified using a fluoroscopic asymmetry index (%), defined as [(longest/shortest balloon‐expandable valve height)−1]×100. The primary end point was 2‐year HF hospitalization. Results During follow‐up, 99 patients (17%) experienced HF hospitalization. As a continuous variable, asymmetry index (%) was not independently associated with 2‐year HF (adjusted hazard ratio [HR] per 1% increase, 1.02 [95% CI, 0.98–1.06]). Restricted cubic spline analysis demonstrated no significant linear or nonlinear association (overall P =0.71; P for nonlinearity=0.89), although the risk curve suggested increased HF risk beyond moderate valve asymmetry. Exploratory threshold analysis identified an asymmetry index cutoff of 7.48%. Patients above this threshold had a higher incidence of HF hospitalization than those below it (23.6% versus 15.8%; log‐rank P =0.043), despite comparable rates of impaired valve performance at discharge. Valve asymmetry >7.48% remained independently associated with late HF occurring beyond 30 days after TAVR (adjusted HR, 1.69 [95% CI, 1.10–2.60]). Conclusions Fluoroscopic assessment of balloon‐expandable valve expansion identified patients with marked valve asymmetry at increased risk of late HF after TAVR, despite preserved early valve performance. These findings support the potential value of intraprocedural valve geometry assessment for long‐term risk stratification and warrant further investigation.
The authors' abstract, as published at the source. Journal of the American Heart Association, 2026 · DOI ↗
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Field: Cardiology and Cardiovascular Medicine
Cardiology and Cardiovascular MedicineMedicine