A novel angiographic parameter associated with periprocedural myocardial injury in TAVI patients; aortic sinus valsalva flushing time

Background and Objective: Periprocedural myocardial injury (PPMI) following transcatheter aortic valve implantation (TAVI) is an important complication that may adversely affect patient prognosis. In this study, we aimed to define a new angiographic parameter termed "Aortic Sinus Valsalva Flushing Time" (ASVFT) and to investigate its relationship with PPMI in patients undergoing TAVI. Materials and Methods: This study was approved by the Local Ethics Committee of the Faculty of Medicine, Samsun University (10/07/2024). Patients who underwent TAVI for severe aortic stenosis at Samsun Training and Research Hospital between 01.01.2022 and 01.04.2024 were retrospectively and consecutively included, based on the 2021 ESC valvular heart disease guidelines. Patients were categorized as having high-gradient severe aortic stenosis (mean gradient ≥40 mmHg, AVmax ≥4 m/s, AVA<1.0) or low-gradient severe aortic stenosis (mean gradient <40 mmHg, AVmax<4 m/s, AVA<1.0). ASVFT was measured from preoperative angiographic images. The relationship between ASVFT and periprocedural myocardial injury was evaluated using high-sensitivity Troponin I levels measured at baseline and at 24 hours post-procedure. Patients were considered to have PPMI if post-procedural troponin levels were more than twice the baseline. Diagnosis of myocardial injury was made based on VARC-3 criteria. Statistical analyses were performed using IBM SPSS Statistics version 22. Results: Periprocedural myocardial injury (PPMI) was detected in 91.5 % (n=183) of the 200 patients included in study. The anjiographic parameter we defined as ASVFT was found to be significantly longer in the group with myocardial injury. In logistic regression analysis, each 1-frame increase in ASVFT duration was associated with a 1.588-fold increase in the likelihood of developing myocardial injury (OR: 1.588; 95% CI: 1.271-19.83; p<0.001). Additionally, each 1% increase in preoperative left ventricular ejection fraction (LVEF) increased this risk by 1.055-fold (p=0.039). According to the ROC analysis, ASVFT demonstrated discriminatory power in predicting PPMI, with an area under the curve (AUC) of 0.788 (p<0.001). A significant correlation was found between ASVFT and 24-hour post-operative troponin I levels (Spearman's rho=0.316; p<0.001). Conclusion: This study suggests that ASVFT, a newly defined angiographic parameter, may serve as a useful predictor for PPMI in patients undergoing TAVI. Given its ease of measurement and objectivity, ASVFT could contribute to early risk stratification and decision-making. The findings highlight the potential clinical applicability of ASVFT and support the need for further validation in larger, prospective studies. Keywords: TAVI, Aortic Stenosis, Periprosedural Myocardial Injury