Prognostic value of algorithm-based invasive haemodynamic assessment of paravalvular regurgitation after transcatheter aortic valve replacement with self-expanding devices—the APPOSE registry

Stens, NA, Versteeg, GAA, Rooijakkers, MJP, Zegers, E, Pisters, R, Jaspers Focks, J, Driesen, BW, Prins, FJ, Remkes, W, van Nunen, LX, van Wely, MH, van Geuns, RJM, Buffart, LM, Cetinyurek-Yavuz, A, Verkroost, MWA, van Garsse, LAFM, Heijmen, RH, Thijssen, DHJ ORCID: 0000-0002-7707-5567 and van Royen, N (2026) Prognostic value of algorithm-based invasive haemodynamic assessment of paravalvular regurgitation after transcatheter aortic valve replacement with self-expanding devices—the APPOSE registry. European Heart Journal - Valvular and Structural Heart Disease, 2 (3). pp. 1-9. ISSN 2977-8565

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Abstract

Background
Detecting and grading paravalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR) remains challenging.

Aims
We evaluated the prognostic value of algorithm-based invasively measured haemodynamic indices of PVR for all-cause mortality and heart failure (HF) rehospitalizations.

Methods and Results
We included 727 patients who underwent TAVR with a self-expanding valve for severe native aortic stenosis between 2015 and 2021 at Radboudumc. Invasive left ventricular and aortic pressures were continuously measured and analysed offline using a validated algorithm for standardized computation of haemodynamic indices of PVR. The primary endpoint was an event-adjudicated composite of all-cause mortality and HF rehospitalization across 3-year follow-up. Algorithm-derived diastolic pressure–time index (DPTI) ≤58 and diastolic delta (DD) ≤32 mmHg were independently associated with the composite outcome (hazard ratio [HR] 1.64 [95% confidence interval (CI): 1.14, 2.37], HR 1.80 [95% CI: 1.21, 2.68], respectively). Following stratification for angiography-graded PVR, algorithm-derived invasive indices remained independently associated with the composite outcome in those with angiographic mild-moderate (HR DPTI ≤58 mmHg: 2.94, 95% CI: 1.68, 5.15) but not none/trace PVR (HR DPTI ≤58 mmHg: 0.91, 95% CI: 0.49, 1.69). Inferences remained consistent when considering only those with angiographic mild PVR (HR DPTI ≤58: 3.19, 95% CI: 1.62, 6.26).

Conclusion
Algorithm-based invasive assessment of PVR showed independent prognostic value for the risk of all-cause mortality and HF rehospitalization across 3-year follow-up. Additionally, following stratification for angiography-graded PVR, haemodynamic indices remained independently associated with the composite outcome in those with angiographic mild PVR. Together, this highlights the potential of real-time automated assessment of invasive haemodynamics for risk stratification of patients undergoing TAVR.

Item Type:	Article
Uncontrolled Keywords:	32 Biomedical and Clinical Sciences; 3201 Cardiovascular Medicine and Haematology; 3202 Clinical Sciences; Clinical Research; Heart Disease; Transplantation; Bioengineering; Cardiovascular; 4.2 Evaluation of markers and technologies; Cardiovascular; 3 Good Health and Well Being
Subjects:	R Medicine > RC Internal medicine
Divisions:	Sport and Exercise Sciences
Publisher:	Oxford University Press
Date of acceptance:	20 July 2026
Date of first compliant Open Access:	15 September 2026
Date Deposited:	15 Sep 2026 13:41
Last Modified:	15 Sep 2026 13:41
DOI or ID number:	10.1093/ehjvshd/xwag060
URI:	https://researchonline.ljmu.ac.uk/id/eprint/29433

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