# Routine preprocedurale data voorspelt linkerventrikelherstel na TAVR en identificeert cardiorenal fenotype

*geplaatst 2026-09-23 · Algemeen · International journal of cardiology. Heart & vasculature · doi 10.1016/j.ijcha.2026.101999 · https://hartvaat.nl/2026/10/01/routine-preprocedurale-data-voorspelt-linkerventrikelherstel-na-tavr-en-identifi/*

In een cohort van 1212 patiënten die een TAVR ondergaan voor ernstige aortastenose toont aan dat routine preprocedurale data vier fenotypes definieert, waaronder een specifiek cardiorenal profiel met een hoge niet-cardiovasculaire mortaliteit. Voor patiënten met een baseline LVEF <50% kan een parsimonieus model (TAVR-RECOVER score) met een AUC van 0,75 voorspellen welke patiënten een significante verbetering van de LVEF ervaren (van gemiddeld 38% naar 59% na 1 jaar). Deze bevindingen suggereren dat routine laboratorium- en echografische parameters de huidige risicostratificatie kunnen aanvullen, waarbij een verminderde nierfunctie de excess mortaliteit in het cardiorenale fenotype verklaart.

## English: Predicting left-ventricular recovery and characterizing Cardiorenal risk after Transcatheter aortic valve replacement: A routine-data phenotyping and prediction-model study.

In a cohort of 1,212 patients undergoing TAVR for severe aortic stenosis, unsupervised clustering of routine preprocedural data identified four distinct phenotypes, including a cardiorenal subgroup with high noncardiovascular mortality. For patients with baseline LVEF <50%, a parsimonious prediction model (TAVR-RECOVER score) incorporating LV end-diastolic diameter, mean gradient, and coronary disease achieved an AUC of 0.75 to identify those likely to experience a ≥10-point LVEF improvement (mean increase from 38% to 59% at 1 year). These findings suggest that readily available clinical parameters can refine post-TAVR recovery expectations and highlight renal dysfunction as the primary driver of excess mortality in the cardiorenal phenotype, though external validation is needed before clinical implementation.

## Abstract (original, from the publication)

BACKGROUND: Ejection fraction (LVEF) underpins risk stratification before transcatheter aortic valve replacement (TAVR), yet it does not indicate whether an impaired ventricle will recover once the stenosis is relieved, or what drives death in high-risk patients. We asked whether routine preprocedural data could address both. METHODS AND RESULTS: Among 1212 consecutive patients (1213 procedures) who underwent TAVR for severe aortic stenosis (2012-2026), unsupervised clustering of 18 routine variables (principal components, Ward linkage) defined four phenotypes: low-risk, elderly preserved-EF, reduced-EF, and cardiorenal. Five-year mortality ranged from 13.5% to 44.2% (P < 0.001). Among 180 patients with a baseline LVEF below 50%, a parsimonious model combining LV end-diastolic diameter, mean gradient, and coronary disease predicted a ≥ 10-point LVEF gain (optimism-corrected AUC, 0.75; 0.65 for LVEF alone, a difference that was not statistically significant in this sample), and an integer TAVR-RECOVER score stratified observed recovery from 69% to 98%. Reduced-EF patients recovered from a mean LVEF of 38% to 59% by 1 year. The cardiorenal phenotype carried a 3.4-fold age-adjusted mortality (95% CI, 2.0-5.6) but died chiefly of noncardiovascular causes (5-year incidence, 32% versus 13% cardiovascular); its excess risk became non-significant after adjustment for renal function and other routine laboratories (hazard ratio, 1.60; 95% CI, 0.61-4.17). Phenotype re-stratified mortality within each LVEF category, with an almost 3-fold gradient among preserved-EF patients. CONCLUSIONS: Routine preprocedural data can estimate which impaired ventricles recover after TAVR and identify a cardiorenal phenotype whose excess, largely noncardiovascular mortality is statistically explained by measurable renal dysfunction rather than captured by ejection fraction. Prospective external validation is warranted.

Auteurs: Fuhai Li, Yongchao Zhao, Wei Luo, Jingmin Zhou, Chun Xiao, Junbo Ge

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Bron: International journal of cardiology. Heart & vasculature, https://doi.org/10.1016/j.ijcha.2026.101999. Bijgewerkt 2026-09-16T01:11:52Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.