Transcatheter aortic valve replacement (TAVR) has revolutionized the prognosis of patients with severe aortic stenosis. Four categories of aortic stenosis can be defined depending on left ventricular ejection fraction (EF), mean transvalvular gradient and stoke volume index.

Whether aortic stenosis category influence prognosis after TAVR regarding functional improvement and mortality.

In total, 263 TAVR patients with a complete baseline echocardiography and one year follow-up, were retrospectively classified into four categories: high gradient (n=211); low-flow, low-gradient aortic stenosis with reduced EF (n=21); low-flow, low-gradient aortic stenosis with preserved EF (n=8) and normal-flow, low-gradient aortic stenosis with preserved EF (n=23).

At 12 months follow-up, 39 deaths occurred (14.8%): 25 in the high gradient group (11.8%), 9 in the low-gradient, low-flow, reduced EF group (43%), 1 in the low-gradient, low-flow, preserved EF group (12.5%), 4 in the low-gradient, normal flow group (17.4%). In a multivariate model, one-year all-cause mortality was higher in low-gradient, low-flow, reduced EF group (P<0.0001) than in others (HR=3.86; 95% CI 1.83–8.14; P=0.0004). Patients with low-gradient, low-flow, reduced EF had less improvement in terms of dyspnea one month after the procedure with more patients in the NYHA 4 stage in this group (P=0.003).

A complete echocardiography is necessary to evaluate aortic stenosis, its severity and its type before TAVR. Patients with low-gradient, low-flow reduced EF had a higher mortality rate one year after TAVR and remained more symptomatic one month after the procedure.