Predictors of heart failure (HF) recurrence after Transcatheter aortic valve implantation (TAVI) are insufficiently characterized. The newly developed CAPRI score encompassing aortic calcification burden, is predictive of 1-year post-TAVI cardiovascular and all-cause mortalities (Lantelme et al., JACC Img 2018).

1) to assess the prognostic significance of CAPRI score for HF recurrence during the first year after TAVI; 2) to test this prognostic significance according to aortic gradient.

The CAPRI-HF is an ancillary study of the C4CAPRI trial (NCT02935491) including 409 consecutive patients from Rouen and Lyon University hospitals, treated between 2010 and 2014. The primary outcome was defined as hospitalization for HF during the first year after TAVI. The prognostic value of the CAPRI score was assessed by cox regression; an interaction between mean aortic gradient and CAPRI score was further tested.

Among the 409 patients, 392 were finally included (14 peri-procedural deaths and 3 lost of follow-up). Seventy-eight patients (19.9%) experienced HF during the first year after TAVI. In multivariate cox analysis adjusted for diabetes, atrial fibrillation, vascular route, pacemaker implantation, aortic regurgitation, transfusion, post-TAVI pulmonary pressure, only CAPRI score was predictive of HF: Hazard Ratio (HR) 1.89, 95% Confidence Interval (CI) [1.23–2.87]. A significant interaction between CAPRI score and mean aortic gradient was found (P<0.05). When restricting the analysis to low-flow-low-gradient aortic stenosis, CAPRI score was a stronger predictor of HF (HR 2.68, 95% CI [1.34–5.35]). In the overall cohort, a CAPRI score above a 25% cardiovascular mortality threshold was associated with a 36% rate of HF in comparison to 18.8% HF rate when the score was below (P<0.05).

The CAPRI score is the only score able to predict both mortality and HF after TAVI. It should now belong to the panoply of the Heart-Team.