The TAVR-PRO score, based on five readily available variables, is a simple and effective tool for predicting poor functional outcomes and mortality after TAVR in older adults.
Key Findings
Methods
A retrospective cohort of 204 elderly patients undergoing TAVR was used to develop and validate a risk prediction score for poor 6-month functional outcomes.
Patients were aged ≥65 years (106 males and 98 females) with severe aortic stenosis treated between March 2021 and March 2024.
Patients were randomly split into a training cohort (n=143) and a validation cohort (n=61).
The primary endpoint was poor functional outcome at 6 months, defined as a composite of failure to improve LVEF by >10% and failure to increase 6-minute walk test (6MWT) distance by >50 meters.
LASSO regression was used in the training cohort to identify predictors and construct the risk score.
Results
Five independent predictors were identified and incorporated into the TAVR-PRO (Transcatheter Aortic Valve Replacement - Poor Recovery Outcome) risk score.
The five predictors were: advanced age (≥80 years), Clinical Frailty Scale (CFS) >4, NT-proBNP >3000 pg/mL, coronary artery disease, and chronic kidney disease (eGFR <45 mL/min/1.73m²).
All five variables are described as 'readily available' in routine clinical practice.
Predictors were identified through LASSO regression in the training cohort.
Results
The TAVR-PRO score demonstrated good discrimination in both the training and validation cohorts.
AUC in the training cohort was 0.88.
AUC in the validation cohort was 0.86.
The model also demonstrated excellent calibration in both cohorts, as assessed by calibration plots.
Results
Higher TAVR-PRO scores were significantly associated with poor functional outcome and increased 1-year all-cause mortality.
The association between higher scores and both poor functional outcome and increased 1-year all-cause mortality was statistically significant (P < 0.001).
1-year all-cause mortality was analyzed as a secondary endpoint using Kaplan-Meier curves.
The score stratified patients into risk groups with meaningfully different survival and functional recovery rates.
Conclusions
The TAVR-PRO score is proposed as a tool to aid shared decision-making, patient counseling, and identification of high-risk individuals for targeted interventions.
The score is characterized as 'simple and effective' due to its reliance on five readily available clinical variables.
The authors suggest it can be used in clinical practice for older adults being considered for or recovering from TAVR.
The score addresses the recognized clinical problem that a subset of older adults experience poor functional recovery despite overall TAVR success.
What This Means
This research suggests that a new clinical tool called the TAVR-PRO score can reliably predict which elderly patients are unlikely to recover well after a minimally invasive heart valve procedure called transcatheter aortic valve replacement (TAVR). TAVR is used to treat severe narrowing of the aortic valve, and while it is generally successful, some older patients do not regain good heart function or physical capacity afterward. The researchers studied 204 patients aged 65 and older and found that five factors — being 80 or older, being frail, having very elevated levels of a heart stress marker (NT-proBNP), having coronary artery disease, and having significant kidney disease — were the strongest predictors of poor recovery at six months.
The TAVR-PRO score built from these five factors performed well in both the group used to develop it and a separate group used to test it, with accuracy scores (AUC) of 0.88 and 0.86 respectively, indicating strong predictive ability. Patients with higher scores were also significantly more likely to die within one year. Importantly, all five factors are routinely measured before TAVR, making the score practical to use without additional testing.
This research suggests that the TAVR-PRO score could help doctors and patients have more informed conversations before undergoing TAVR, particularly for elderly individuals with multiple risk factors. It may help identify patients who need more intensive support or follow-up care, and could assist in situations where the potential benefits of the procedure need to be weighed carefully against the likelihood of meaningful recovery.
Zhang H, Wang H, Ma Q, Shi F, An J. (2026). Development and Validation of a Predictive Risk Score for Poor Functional Outcome After Transcatheter Aortic Valve Replacement in Elderly Patients.. Clinical interventions in aging. https://doi.org/10.2147/CIA.S581799