Long-Term Outcomes of Targeted Volume Overload Management in Patients With Severe Aortic Stenosis

Autherith, M; Halavina, K; Hauptmann, L; Koschatko, S; Jantsch, C; Heitzinger, G; Dannenberg, V; Danesh, D; Demirel, C; Hengstenberg, C; Mascherbauer, J; Bartko, PE; Nitsche, C

doi:10.1016/j.jacadv.2026.102705

Long-Term Outcomes of Targeted Volume Overload Management in Patients With Severe Aortic Stenosis

JACC AdvPublished 1 Apr 2026randomized trial

Primary result · Composite of heart failure hospitalization (HFH) and all-cause deathResultHazard ratio 0.40 95% CI 0.20–0.79

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Authors' conclusion

In patients with severe AS and VO, outcome benefits of BIS-targeted decongestive treatment persist up to 3 years after TAVR.

Study context

Population: Patients with severe aortic stenosis (AS) scheduled for transcatheter aortic valve replacement (TAVR), with or without volume overload (VO) defined by bioimpedance spectroscopy (BIS) (≥1.0 L and/or ≥7%)
Participants: 55 / 56 / 121

Comparison: BIS-guided decongestion vs decongestion as per clinical judgment alone
BIS-guidedn = 55
non-BIS-guidedn = 56reference
Euvolemic control groupn = 121
Primary endpoint: Composite of:
Heart failure hospitalization (HFH)
All-cause death
Follow-up: 36 months

Methodological details1:1 randomization, euvolemic control group, 36-month follow-up

1:1 randomization
Euvolemic control group
36-month follow-up

Primary result

As reported in the abstract

Hazard ratio

0.40

95% CI 0.20–0.79

By group

BIS-guided21.8%

non-BIS-guided46.4%

BIS-guidedvs non-BIS-guided

HR 0.40 (95% CI 0.20–0.79)

Secondary outcomes

Outcome	← Lower risk with BIS-guided ←→ Higher risk with BIS-guided →	HR (95% CI)
MortalityBIS-guidedvs non-BIS-guided	0.20.5125	0.54 (0.26–1.14)
	0.20.5125Hazard ratio (log scale)

Outcome	BIS-guided	non-BIS-guided	P value
Cumulative incidence of first HFH	3.6% (95% CI 0.7–11.2)	25.0% (95% CI 14.5–37.0)
HFH frequencyBIS-guided vs non-BIS-guided · reduced HFH frequency with BIS-guided	28 per 1,000 patient years	173 per 1,000 patient years	P < 0.001

Diuretic doses · throughout the entire study

Higher diuretic doses in the BIS-guided group compared to the non-BIS-guided group

Original publication

Long-Term Outcomes of Targeted Volume Overload Management in Patients With Severe Aortic Stenosis. JACC Adv. Published 1 April 2026. doi:10.1016/j.jacadv.2026.102705

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