Valvular & structural heart diseaseDiagnostic or prognostic study
Phenotyping patients with a low-flow, low-gradient aortic stenosis and a preserved ejection fraction undergoing transcatheter aortic valve implantation
- unsupervised echocardiographic clustering
- Principal component analysis
- K-means clustering
- internal and external validation
Authors' conclusion
One-third of TAVI patients with LF-LG aortic stenosis have an typical HFpEF/AF phenotype and a poor prognosis. They may benefit from guideline-directed HFpEF therapy, including SGLT-2 inhibitors and MRA.
Study context
- Population
- Patients with low flow, low-gradient (LF-LG) aortic stenosis and preserved ejection fraction undergoing transcatheter aortic valve implantation (TAVI) (UMCG, the Netherlands)patients undergoing TAVI, 216/628 patients with complete data had LF-LG preserved ejection fraction (pEF) · internal validation 405 · external validation (TUMunich, Germany) 173
- Participants
- 827 patients
- Comparison
- cluster 1 versus cluster 2
- cluster 1n = 77
- cluster 2n = 139
Performance
As reported in the abstract
LF-LG pEF prevalence
patients with complete data who had LF-LG pEF
216/628 (34%)
mean age
78.8 (± 7.19) years
female
57.9%
Further findings
| Outcome | cluster 1 | cluster 2 |
|---|---|---|
| Echocardiographic and clinical features | ||
| H2FPEF score ≥6 | 49.4% | Not reported in the abstract |
| HFA-pEFF score ≥5 | 71.4% | Not reported in the abstract |
Echocardiographic and clinical features
- Cluster 1: larger left and right atrial dimensions, impaired left ventricular global longitudinal strain, reduced left atrial reservoir strain; older, higher rates of atrial fibrillation (AF) and heart failure (HF) versus cluster 2
Cardiovascular mortality and HF-hospitalization · 1- and 5-year
- Cluster 1 had higher risk, comparable to that of classical LF-LG patients
- Validation reproduced these results
Original publication
Phenotyping patients with a low-flow, low-gradient aortic stenosis and a preserved ejection fraction undergoing transcatheter aortic valve implantation. ESC Heart Fail. Published 31 May 2026. doi:10.1093/eschf/xvag146
Summarised from the published abstract; every number is checked against it