Combined assessment of pulmonary artery pulsatility index and pulmonary arterial capacitance for risk stratification following transcatheter aortic valve implantation

Background: Right heart haemodynamics, including right ventricular function and pulmonary arterial capacitance (PAC), are important prognostic determinants in cardiovascular disease. However, their combined role in patients undergoing transcatheter aortic valve implantation (TAVI) remains unclear. This study aimed to determine whether the combined assessment using pulmonary artery pulsatility index (PAPi) and PAC can stratify clinical outcomes in patients with aortic stenosis (AS) undergoing TAVI. Methods: This retrospective single-centre study included 77 patients with severe AS who underwent right heart catheterisation within 3 months before TAVI. Patients were stratified into four groups based on the median values of PAPi and PAC. The primary endpoint was a composite of all-cause death or heart failure-related hospitalisation. Results: During a median follow-up of 3.60 years (interquartile range: 1.89–4.62), 15 patients experienced the primary endpoint. Kaplan–Meier’s analysis showed significant stratification by PAPi–PAC groups (log-rank p = 0.040). In Cox regression models, the low PAPi/low PAC group was independently associated with adverse outcomes compared with the other groups (hazard ratio (HR): 3.65, 95% confidence interval (CI): 1.28–10.40, p = 0.015 adjusted for age and sex; HR: 3.61, 95% CI: 1.27–10.26, p = 0.016 adjusted for natriuretic peptide levels; HR: 3.07, 95% CI: 1.07–8.81, p = 0.038 adjusted for the Meta-analysis Global Group in Chronic Heart Failure score). Conclusions: Combined PAPi–PAC assessment identified distinct haemodynamic phenotypes with prognostic significance following TAVI. This approach offers a simple, physiologically grounded framework for postprocedural risk stratification and individualised management.