Trajectories of cardiac damage staging after transcatheter aortic valve replacement and long-term outcomes

Cardiac Damage Staging (CDS) is associated with prognosis and may evolve after transcatheter aortic valve replacement (TAVR). However, the prognostic value of CDS at 1-year and the trajectory of CDS, and its underlying factors, remains unclear. From a single-center registry, patients who underwent TAVR between 2016 and 2023 and had echocardiographic assessment at baseline, immediately post-TAVR, and 1-year, were included. We evaluated (1) temporal changes in CDS, (2) factors associated with CDS evolution, and (3) the association between 1-year CDS and long-term survival. CDS was assessed using the original schema and dichotomized as early stage (stage 0-2) versus advanced stage (stage 3-4). Among 762 patients, 676 were classified as early stage and 86 as advanced stage at baseline. In the baseline early stage group, 25 (3.7%) worsened to advanced stage immediately post-TAVR, and 48 (7.1%) had worsened by 1-year. Among baseline advanced stage group, 39 (45.3%) improved to early stage immediately post-TAVR, increasing to 50 (58.1%) at 1-year. Absence of baseline atrial fibrillation (AF) was associated with CDS improvement, whereas baseline AF and mild tricuspid regurgitation (TR) were associated with CDS worsening. Advanced stage CDS at 1-year was associated with higher all-cause mortality (adjusted HR 1.90; 95% CI 1.10-3.29; p = 0.02). Among the baseline early stage group, worsening to advanced stage was associated with a two-fold higher mortality risk. CDS evolves during the first year post-TAVR and is influenced by AF and TR. CDS at 1-year after TAVR was associated with long-term survival.