Objective Transcatheter aortic valve replacement (TAVR) improves clinical symptoms in most patients with severe aortic stenosis (AS). However, some patients do not benefit from the symptom-reducing effects of TAVR. We assessed the predictors and clinical outcomes of poor symptomatic improvement (SI) after TAVR. Methods A total of 1749 patients with severe symptomatic AS undergoing transfemoral TAVR were evaluated using the Japanese multicentre TAVR registry. Poor SI was defined as readmission for heart failure (HF) within 1 year after TAVR or New York Heart Association (NYHA) class ≥3 after 1 year. A logistic regression model was used to identify predictors of poor SI. One-year landmark analysis after TAVR was used to evaluate the association between poor SI and clinical outcomes. Results Among the overall population (mean age, 84.5 years; female, 71.3%; mean STS score, 6.3%), 6.6% were categorised as having poor SI. Atrial fibrillation, chronic obstructive pulmonary disease, Clinical Frailty Scale ≥4, chronic kidney disease and moderate to severe mitral regurgitation were independent predictors of poor SI. One-year landmark analysis demonstrated that poor SI had a higher incidence of all-cause death and readmission for HF compared with SI (p<0.001). Poor SI with preprocedural NYHA class 2 had a worse outcome than SI with preprocedural NYHA class ≥3. Conclusions Poor SI was associated with worse outcomes 1 year after the procedure. It had a greater impact on clinical outcomes than baseline symptoms. TAVR may be challenging for patients with many predictors of poor SI. Trial registration number This registry, associated with the University Hospital Medical Information Network Clinical Trials Registry, was accepted by the International Committee of Medical Journal Editors (UMIN-ID: 000020423). No data are available. The data in this research are deidentified participant data. The data, materials will not be available to researchers for purpose of reproducing the results or replicating the procedure.

中文翻译：

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经导管主动脉瓣置换术后症状改善不佳的预测因素和临床结果

目的经导管主动脉瓣置换术（TAVR）可改善大多数严重主动脉瓣狭窄（AS）患者的临床症状。然而，一些患者不能从 TAVR 的症状减轻作用中受益。我们评估了 TAVR 后症状改善 (SI) 不佳的预测因素和临床结果。方法 使用日本多中心 TAVR 登记系统对 1749 例接受经股动脉 TAVR 的严重症状性 AS 患者进行评估。SI 差定义为 TAVR 后 1 年内心力衰竭 (HF) 再入院或 1 年后纽约心脏协会 (NYHA) 分级≥3。逻辑回归模型用于识别不良 SI 的预测因子。TAVR 后一年的标志性分析用于评估不良 SI 与临床结果之间的关联。结果 在总人口中（平均年龄 84.5 岁；女性，71.3%；平均 STS 得分，6.3%），6.6% 被归类为 SI 差。心房颤动、慢性阻塞性肺疾病、临床虚弱量表≥4、慢性肾脏疾病和中度至重度二尖瓣关闭不全是不良 SI 的独立预测因素。一年的里程碑分析表明，与 SI 相比，较差的 SI 具有更高的全因死亡和再入院率（p<0.001）。术前 NYHA 等级 2 的不良 SI 的结果比术前 NYHA 等级≥3 的 SI 差。结论 较差的 SI 与术后 1 年较差的结果相关。与基线症状相比，它对临床结果的影响更大。TAVR 可能对具有许多不良 SI 预测因子的患者具有挑战性。试用注册号 本注册处，与大学医院医学信息网络临床试验注册中心相关联，被国际医学期刊编辑委员会接受（UMIN-ID：000020423）。没有可用的数据。本研究中的数据是去识别的参与者数据。研究人员将无法获得这些数据、材料以复制结果或复制程序。