A novel composite inflammatory-metabolic index for long-term prognosis after TAVR: the modifying role of left ventricular ejection fraction.

Background: Metabolic dysfunction and systemic inflammation are increasingly recognized as important determinants of outcomes after transcatheter aortic valve replacement (TAVR). However, whether their prognostic impact differs according to baseline left ventricular systolic function remains unclear. Objectives: To evaluate the association between the TyG-SII composite index (TSI), an inflammatory-metabolic biomarker, and long-term outcomes after TAVR and to determine whether baseline left ventricular ejection fraction (LVEF) modifies this association. Methods: We conducted a retrospective cohort study of patients who underwent TAVR between December 2015 and March 2025. Patients were stratified according to baseline LVEF (≤40% vs. >40%). To reduce confounding, a 1:4 exact matched cohort was constructed according to sex, age category, calendar period of TAVR, and valve type ( Results: During follow-up, 187 deaths occurred: 51 among patients with LVEF ≤ 40% (33.3%) and 136 among those with LVEF > 40% (27.6%). Kaplan-Meier analysis showed no significant difference in overall survival between LVEF groups (log-rank Conclusions: In patients undergoing TAVR, greater inflammatory-metabolic burden, as reflected by TSI, was independently associated with long-term mortality among those with reduced LVEF. Reduced LVEF was also associated with a higher long-term risk of HVD; however, this exploratory finding requires confirmation in larger prospective studies.