Cardiovascular

Prognostic Value of the Frailty Index in Patients with Severe Aortic Regurgitation Undergoing Transcatheter Aortic Valve Replacement.

Yu Q, Fu Q, et al. • Clinical interventions in aging • 2026

PubMed 42974471 DOI 10.2147/CIA.S643768
TL;DR

Among patients undergoing TAVR for severe native aortic regurgitation, a high frailty index was associated with higher one-year mortality.

Key Findings

Results

A cohort-derived frailty index threshold of 0.407 classified 32 of 298 patients with isolated severe AR undergoing TAVR as high frailty.

  • Post hoc analysis of the prospective China DVD2 multicenter cohort, 298 patients with isolated severe AR.
  • Frailty was assessed preprocedurally using an abbreviated 8-9-item cumulative deficit frailty index covering functional, cognitive, nutritional, and clinical domains.
  • The threshold was derived using time-dependent receiver operating characteristic analysis for mortality.
Results

High-frailty patients had a greater symptom burden and more adverse cardiac characteristics at baseline than low-frailty patients.

  • High-FI patients had a higher prevalence of atrial fibrillation.
  • High-FI patients had larger left atrial diameter.
  • High-FI patients had elevated NT-proBNP.
Results

One-year all-cause mortality was significantly higher in the high-FI group than in the low-FI group.

  • Mortality was 15.6% in high-FI vs 3.4% in low-FI patients (P = 0.010).
  • One-year all-cause mortality was the primary endpoint.
Results

High frailty index was independently associated with higher one-year mortality after adjustment for covariates.

  • In Model 3, HR 4.00, 95% CI 1.18-13.50; P = 0.026.
  • Cox models were adjusted for age, sex, body mass index, atrial fibrillation, and NT-proBNP.
  • The wide confidence interval reflects the small number of high-frailty patients (n = 32).
Results

No significant interaction was observed between the frailty index and NT-proBNP.

  • Neither multiplicative nor additive interaction was significant.
  • Subgroup and interaction analyses were performed.
Conclusions

The findings extend prior evidence on frailty's prognostic implications to the understudied population of patients undergoing TAVR for severe native aortic regurgitation.

  • Prognostic value of frailty in native AR treated with TAVR was previously not well defined.
  • The abbreviated cumulative deficit frailty index was used.

What This Means

This study looked at whether frailty, a general state of vulnerability that includes physical function, thinking, nutrition, and other health problems, predicts death after transcatheter aortic valve replacement (TAVR) in people with severe aortic regurgitation, a leaky heart valve. It analyzed 298 patients from a multicenter Chinese cohort, using a short frailty index calculated from 8-9 items assessed before the procedure. Only 32 patients were classified as highly frail. These patients tended to have more symptoms, more atrial fibrillation, larger left atria, and higher levels of NT-proBNP, a blood marker of heart strain. One year after TAVR, 15.6% of highly frail patients had died compared with 3.4% of the others. After adjusting for age, sex, body mass index, atrial fibrillation, and NT-proBNP, high frailty was still associated with about four times the risk of death, though the estimate was imprecise because few patients were highly frail. This research suggests that a quick frailty assessment may help identify patients with aortic regurgitation who are at higher risk after TAVR. The study found no evidence that frailty and NT-proBNP combined to increase risk beyond their separate effects. Because this was a post hoc analysis with a small high-frailty group and a cutoff derived from the same cohort, the results need confirmation in larger studies.

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Citation

Yu Q, Fu Q, Cheng Z, Feng J, Huang X, Gong R, et al.. (2026). Prognostic Value of the Frailty Index in Patients with Severe Aortic Regurgitation Undergoing Transcatheter Aortic Valve Replacement.. Clinical interventions in aging. https://doi.org/10.2147/CIA.S643768