Longitudinal Trajectories of the Atherogenic Index of Plasma and Their Associations with Clinical Outcomes After Transcatheter Aortic Valve Replacement

Background/Objectives: The atherogenic index of plasma (AIP) reflects atherogenic dyslipidemia, but the clinical relevance of its longitudinal patterns after transcatheter aortic valve replacement (TAVR) remains unclear. We aimed to characterize AIP trajectories and explore their associations with clinical outcomes and echocardiographic changes after TAVR. Methods: This retrospective analysis included 1548 patients with at least two AIP measurements from within 7 days before TAVR through follow-up. Group-based trajectory modeling was used to identify longitudinal AIP patterns. Cox proportional hazards models and linear mixed-effects models were applied to assess clinical outcomes and longitudinal echocardiographic changes, respectively. Because trajectory assignment incorporated post-TAVR measurements, the analyses were considered exploratory. Results: Three distinct AIP trajectories were identified: low-level (n = 431, 27.8%), intermediate-level (n = 807, 52.1%), and high-level (n = 310, 20.0%). Higher trajectories were characterized by less favorable cardiometabolic profiles. Compared with the low-level trajectory, neither the intermediate-level trajectory (adjusted HR 0.83, 95% CI 0.60–1.16; p = 0.277) nor the high-level trajectory (adjusted HR 1.09, 95% CI 0.74–1.61; p = 0.663) was significantly associated with major adverse cardiovascular and cerebrovascular events. No significant associations with all-cause mortality or longitudinal echocardiographic recovery were detected. Conclusions: Distinct longitudinal AIP trajectories characterized different cardiometabolic profiles after TAVR, but no statistically significant association with major clinical outcomes or echocardiographic recovery was detected. These findings should be interpreted cautiously given temporal overlap in trajectory ascertainment, selection related to repeated measurements, and limited event numbers.