BACKGROUND The prognostic value of cardiac damage staging classifications across the haemodynamic spectrum of severe aortic stenosis (AS) remains unknown. AIMS We aimed to investigate the prognostic impact of cardiac damage staging classifications in patients with high-gradient AS (HG-AS) and low-gradient AS (LG-AS) undergoing transcatheter aortic valve implantation (TAVI). METHODS In a prospective TAVI registry, five-year mortality was evaluated for early stages of cardiac damage (stage 0, 1, or 2) and advanced stages of cardiac damage (stage 3 or 4) in patients with HG-AS, classical low-flow (LF) LG-AS, LF LG-AS with preserved ejection fraction (pEF), and normal-flow (NF) LG-AS. RESULTS Among 2,090 patients undergoing TAVI, 1,045 patients had HG-AS, 337 patients had classical LF LG-AS, 394 patients had LF LG-AS with pEF, and 314 patients had NF LG-AS. The majority of patients with classical LF LG-AS exhibited advanced cardiac damage (73.6%), followed by LF LG-AS with pEF (55.6%), NF LG-AS (51.6%), and HG-AS (50.6%). Patients with advanced stage cardiac damage had significantly higher mortality after TAVI than those with early stage cardiac damage in all subtypes of AS (adjusted hazard ratio [HRadjusted] 1.66, 95% confidence interval [CI]: 1.34-2.06 for HG-AS; HRadjusted 1.49, 95% CI: 1.02-2.16 for classical LF LG-AS; HRadjusted 1.69, 95% CI: 1.22-2.35 for LF LG-AS with pEF; and HRadjusted 1.52, 95% CI: 1.04-2.32 for NF LG-AS). CONCLUSIONS Cardiac damage staging classifications stratified mortality after TAVI irrespective of AS subtype.

中文翻译：

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心脏损伤分期分类对接受 TAVI 的每种主动脉瓣狭窄亚型的预后影响。

背景严重主动脉瓣狭窄（AS）的血流动力学谱中心脏损伤分期分类的预后价值仍然未知。目的 我们的目的是研究心脏损伤分期分类对接受经导管主动脉瓣植入术 (TAVI) 的高梯度 AS (HG-AS) 和低梯度 AS (LG-AS) 患者的预后影响。方法 在一项前瞻性 TAVI 登记中，评估了 HG-AS、经典低度心脏损伤患者的早期心脏损伤（0、1 或 2 期）和晚期心脏损伤（3 或 4 期）的五年死亡率。流动 (LF) LG-AS、保留射血分数 (pEF) 的 LF LG-AS 和正常流动 (NF) LG-AS。结果 在 2,090 名接受 TAVI 的患者中，1,045 名患者患有 HG-AS，337 名患者患有经典 LF LG-AS，394 名患者患有 LF LG-AS 伴 pEF，314 名患者患有 NF LG-AS。大多数经典 LF LG-AS 患者表现出晚期心脏损害 (73.6%)，其次是 LF LG-AS 伴 pEF (55.6%)、NF LG-AS (51.6%) 和 HG-AS (50.6%)。在所有 AS 亚型中，晚期心脏损伤患者在 TAVI 后的死亡率均显着高于早期心脏损伤患者（HG-AS 的调整后风险比 [HR 调整后] 1.66，95% 置信区间 [CI]：1.34-2.06；HR 调整后）对于经典 LF LG-AS，为 1.49，95% CI：1.02-2.16；对于 LF LG-AS 伴 pEF，HR 调整后的 1.69，95% CI：1.22-2.35；对于 NF LG-AS，HR 调整后的 1.52，95% CI：1.04-2.32 ）。结论 心脏损伤分期分类对 TAVI 后的死亡率进行了分层，无论 AS 亚型如何。