Combined Left and Right Ventricular Dysfunction and 1-Year Outcomes After TAVR

BACKGROUND: Outcomes after transcatheter aortic valve replacement (TAVR) reflect cumulative myocardial injury beyond stenosis. Left ventricular (LV) and right ventricular (RV) dysfunction may present as overlapping but distinct functional profiles in aortic stenosis; the prognostic significance of their coexistence remains uncertain. OBJECTIVES: This study evaluated whether quantitative phenotype-based classification integrating LV longitudinal mechanics and RV-pulmonary arterial (PA) coupling identifies distinct preprocedural functional profiles and improves 1-year risk stratification after TAVR. METHODS: In 280 registry patients undergoing TAVR, LV mechanics were assessed by LV global longitudinal strain (LVGLS), and RV-PA coupling by RV free-wall longitudinal strain-to-pulmonary artery systolic pressure ratio (RVFWLS/PASP). Four LV/RV profiles were defined: no abnormality, isolated LV impairment, isolated RV impairment, and concurrent abnormalities. For modeling, isolated LV and RV impairments were combined as single-axis abnormality. The primary endpoint was 1-year all-cause death or major adverse cardiovascular events. RESULTS: The median follow-up was 368 days (IQR: 312-371 days). The 4 profiles included 113/280 (40.4%) no abnormality, 83/280 (29.6%) isolated LV impairment, 22/280 (7.9%) isolated RV impairment, and 62/280 (22.1%) concurrent abnormalities patients. The primary endpoint occurred in 8/113 (7.1%; 95% CI: 3.1-13.5), 16/83 (19.3%; 95% CI: 11.4-29.4), 6/22 (27.3%; 95% CI: 10.7-50.2), and 33/62 (53.2%; 95% CI: 40.1-66.0) (log-rank P < 0.001). Concurrent abnormalities carried the highest adjusted risk (HR: 5.70; 95% CI: 2.37-13.73; P < 0.001) and improved discrimination (C-index: 0.731 [95% CI: 0.682-0.790] to 0.771 [95% CI: 0.724-0.836]). CONCLUSIONS: Integrating LV longitudinal mechanics and RV-PA coupling identifies distinct preprocedural phenotypes in TAVR patients. Concurrent biventricular impairment denotes a high-risk phenotype and provides incremental risk stratification information for 1-year post-TAVR outcomes.