CONGRESS ABSTRACT

Background : Right ventricular (RV) structural and/or functional impairment is a recognized prognostic marker in severe aortic stenosis. Whether early post-TAVI RV trajectories are prognostically informative, and whether their association with outcomes varies according to left-sided filling pressures, remains unclear. Methods : We conducted a single-center observational study including 107 consecutive patients undergoing transcatheter aortic valve implantation (TAVI) (January 2023–June 2024). Transthoracic echocardiography was performed pre-procedure and reassessed pre-discharge, within 1 week. RV systolic dysfunction was defined as TAPSE <17 mm and/or S’ <9.5 cm/s and/or FAC <35%; RV dilation as RVD1 >40 mm. RV abnormality (D) was defined as dysfunction and/or dilation, generating four trajectories: N to N (persistent normal), D to D (persistent abnormal), D to N (recovery), N to D (new abnormality). Pre-TAVI left-sided filling pressures were estimated by average E/e’ and LAVi. The primary endpoint was late 1-year all-cause mortality (days 31–365) using a landmark approach. Associations were tested with Cox proportional hazards models (unadjusted, age-adjusted, and multivariable including pre-TAVI E/e’ and LAVi), and stratified by E/e’ (<14 vs ≥14). Results : RV trajectories were: N to N n=68, D to D n=18, D to N n=11, N to D n=10. Late (31–365 days) deaths were 27 (25.2%). Compared with N to N, D to D was associated with higher late mortality in the unadjusted model (HR 3.78, p=0.002) and remained significant after adjustment for age, pre-TAVI E/e’, and LAVi (HR 3.91, p=0.015). D to N (HR 2.54, p=0.150) and N to D (HR 0.64, p=0.675) were not significant in the multivariable model. In stratified analyses, D to D predicted mortality in E/e’ <14 (HR 5.28, p=0.016) but not in E/e’ ≥14 (HR 3.06, p=0.236), where age was the only significant predictor (HR 1.27, p=0.021). Conclusions : In a real-world TAVI cohort, persistent RV abnormality (D to D) identifies a high-risk phenotype for late mortality. The prognostic signal appears more evident when pre-TAVI filling pressure markers are not elevated, supporting an integrated left–right framework for post-TAVI risk stratification and warranting confirmation with formal interaction testing in larger cohorts.