Clinical Implications of Cardiac Damage Staging Discrepancies in Patients Undergoing Transcatheter Aortic Valve...

Staging of extravalvular cardiac damage (CD) in patients who undergo transcatheter aortic valve implantation (TAVI) provides important prognostic information. However, the progression of aortic stenosis-related CD does not always follow a strictly sequential pattern. The aim of this study was to evaluate the prevalence and long-term prognostic implications of CD staging discrepancies in TAVI patients.

A total of 2260 patients with symptomatic severe aortic stenosis who underwent TAVI were included. CD staging discrepancy was defined as assignment to a CD stage in the absence of ≥ 1 required criterion for 1 or more preceding stages.

Overall, CD discrepancy occurred in 15.3% of the study cohort and increased to 52.4% in patients classified as stage 4 (right ventricular damage). Of these, only 49.6% fulfilled criteria for stage 3 (tricuspid valve or pulmonary vasculature damage). In the overall population, CD discrepancy was not associated with differences in long-term survival. However, within stage 4, patients without discrepancy consistently had worse outcomes, with higher all-cause mortality at 30 days (6.0% vs 2.4%; P = 0.024), 1 year (17.3% vs 9.6%; P = 0.004), and 5 years (44.0% vs 35.5%; P = 0.024) compared with those who exhibited discrepancy. Absence of discrepancy was independently associated with 5-year mortality in stage 4 patients (adjusted hazard ratio, 1.42; 95% confidence interval, 1.07-1.87; P = 0.014).

CD staging discrepancy was common, particularly among patients classified as stage 4. Although discrepancy status was not associated with outcomes in the overall study population, it identified distinct phenotypes with markedly different prognoses within stage 4. These findings highlight important heterogeneity among patients currently classified within the same stage of CD and might inform future refinements of the CD staging framework.