{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T06:23:53Z","timestamp":1787639033699,"version":"build-2736575974"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the association between the TyG\u2013SII composite index (TSI), an inflammatory\u2013metabolic biomarker, and long-term outcomes after TAVR and to determine whether baseline left ventricular ejection fraction (LVEF) modifies this association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective cohort study of patients who underwent TAVR between December 2015 and March 2025. Patients were stratified according to baseline LVEF (\u226440% vs. &amp;gt;40%). To reduce confounding, a 1:4 exact matched cohort was constructed according to sex, age category, calendar period of TAVR, and valve type (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009646). TSI was calculated from pre-procedural laboratory values and analyzed as a continuous standardized variable (per 1-SD increase). Long-term all-cause mortality was assessed using Cox proportional hazards models stratified by LVEF. A separate 1:4 time-dependent matched cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009224) was used to evaluate the association between LVEF and long-term hemodynamic valve deterioration (HVD).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During follow-up, 187 deaths occurred: 51 among patients with LVEF\u2009\u2264\u200940% (33.3%) and 136 among those with LVEF\u2009&amp;gt;\u200940% (27.6%). Kaplan\u2013Meier analysis showed no significant difference in overall survival between LVEF groups (log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.225). In multivariable analyses, each 1-SD increase in standardized TSI was independently associated with higher mortality among patients with LVEF\u2009\u2264\u200940% (adjusted HR, 1.38; 95% CI, 1.10\u20131.73;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.005), but not among those with LVEF\u2009&amp;gt;\u200940% (adjusted HR, 1.02; 95% CI, 0.84\u20131.24;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.818). Patients with reduced LVEF also exhibited a higher long-term risk of HVD compared with matched controls (adjusted HR, 1.71, 95% CI, 1.00\u20132.91,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients undergoing TAVR, greater inflammatory\u2013metabolic 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1912257","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:35:38Z","timestamp":1787636138000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A novel composite inflammatory\u2013metabolic index for long-term prognosis after TAVR: the modifying role of left ventricular ejection fraction"],"prefix":"10.3389","volume":"13","author":[{"given":"Haitham","family":"Abu Khadija","sequence":"first","affiliation":[{"name":"Heart Center, Kaplan Medical Center, Rehovot, Affiliated with the Hebrew University","place":["Jerusalem, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nizar","family":"Abu Hamdeh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine B, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem","place":["Jerusalem, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duha","family":"Najajra","sequence":"additional","affiliation":[{"name":"Palestinian Clinical Research Center","place":["Bethlehem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kareem","family":"Ibraheem","sequence":"additional","affiliation":[{"name":"Palestinian Clinical Research Center","place":["Bethlehem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jebrin","family":"Alkrinawi","sequence":"additional","affiliation":[{"name":"Heart Center, Kaplan Medical Center, Rehovot, Affiliated with the Hebrew University","place":["Jerusalem, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Hroub","sequence":"additional","affiliation":[{"name":"Palestinian Clinical Research Center","place":["Bethlehem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahya Z.","family":"Fraitekh","sequence":"additional","affiliation":[{"name":"Palestinian Clinical Research Center","place":["Bethlehem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Masu'd","sequence":"additional","affiliation":[{"name":"Palestinian Clinical Research Center","place":["Bethlehem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdalaziz","family":"Darwish","sequence":"additional","affiliation":[{"name":"Palestinian Clinical Research Center","place":["Bethlehem, Palestine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Alnees","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine B, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem","place":["Jerusalem, Israel"]},{"name":"Palestinian Clinical Research Center","place":["Bethlehem, Palestine"]},{"name":"Postgraduate Medical Education, Global Clinical Scholar Research Training Program, Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1844","DOI":"10.3390\/jcm14061844","article-title":"Transcatheter aortic valve implantation and replacement: the latest advances and prospects","volume":"14","author":"Brankovic","year":"2025","journal-title":"J Clin Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2143","DOI":"10.1007\/s11739-023-03388-4","article-title":"Long-term outcomes of low-risk patients treated with transcatheter aortic valve replacement versus surgical aortic valve replacement: results from a meta-analysis","volume":"18","author":"Tariq","year":"2023","journal-title":"Intern Emerg Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/j.amjcard.2023.06.025","article-title":"Outcomes of transcatheter aortic valve replacement in patients with severely reduced left ventricular systolic function in the low systolic function and transcatheter aortic valve implantation (LOSTAVI) international registry","volume":"201","author":"Giordano","year":"2023","journal-title":"Am J Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"3639","DOI":"10.3390\/jcm13133639","article-title":"Prognostic impact of left ventricular ejection fraction improvement after transcatheter aortic valve replacement","volume":"13","author":"Reichl","year":"2024","journal-title":"J Clin Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"132663","DOI":"10.1016\/j.ijcard.2024.132663","article-title":"Triglyceride-glucose index (TyG) as a novel biomarker in the era of cardiometabolic medicine","volume":"418","author":"Avagimyan","year":"2025","journal-title":"Int J Cardiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.ejim.2024.08.026","article-title":"Triglyceride glucose (TyG) index: a promising biomarker for diagnosis and treatment of different diseases","volume":"131","author":"Sun","year":"2025","journal-title":"Eur J Intern Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.3390\/jcm12031128","article-title":"Systemic immune inflammation index (SII), system inflammation response index (SIRI) and risk of all-cause mortality and cardiovascular mortality: a 20-year follow-up cohort study of 42,875 US adults","volume":"12","author":"Xia","year":"2023","journal-title":"J Clin Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"21464","DOI":"10.1038\/s41598-025-06770-8","article-title":"Combined association of triglyceride\u2013glucose index and systemic inflammation index on all-cause and cardiovascular mortality","volume":"15","author":"Liu","year":"2025","journal-title":"Sci Rep"},{"key":"B9","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1186\/s12944-024-02277-9","article-title":"The association between triglyceride-glucose index and its combination with systemic inflammation indicators and all-cause and cardiovascular mortality in the general US population: NHANES 1999\u20132018","volume":"23","author":"Chen","year":"2024","journal-title":"Lipids Health Dis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2021\/6628405","article-title":"Incidence and impact of routine inflammatory parameters on outcome after transcatheter aortic valve replacement","volume":"2021","author":"Patsalis","year":"2021","journal-title":"J Interv Cardiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s12893-025-03383-w","article-title":"The correlation between the systemic immune-inflammatory index and the risk of major adverse cardiovascular events after transcatheter aortic valve replacement: a retrospective cohort study","volume":"26","author":"Han","year":"2026","journal-title":"BMC Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1111\/1440-1681.12206","article-title":"Association of inflammation, myocardial fibrosis and cardiac remodelling in patients with mild aortic stenosis as assessed by biomarkers and echocardiography","volume":"41","author":"Park","year":"2014","journal-title":"Clin Exp Pharmacol Physiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"412","DOI":"10.23736\/S2724-5683.25.06956-X","article-title":"Integrating inflammatory and nutritional markers: the prognostic value of the platelet-to-lymphocyte\/albumin ratio for one-year all-cause mortality in patients undergoing transcatheter aortic valve implantation","volume":"74","author":"Buonpane","year":"2026","journal-title":"Miner Cardiol Angiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"100684","DOI":"10.1016\/j.ahjo.2025.100684","article-title":"Triglyceride\u2013glucose index predicts early, short-term, and long-term mortality after transcatheter aortic valve replacement","volume":"61","author":"Abu Khadija","year":"2026","journal-title":"Am Heart J Plus: Cardiol Res Pract"},{"key":"B15","doi-asserted-by":"publisher","first-page":"588","DOI":"10.3390\/medicina57060588","article-title":"Prognostic value of systemic immune-inflammation index for major adverse cardiac events and mortality in severe aortic stenosis patients after TAVI","volume":"57","author":"Tosu","year":"2021","journal-title":"Medicina (B Aires)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"4180","DOI":"10.3390\/jcm10184180","article-title":"Durability of transcatheter heart valves: standardized definitions and available data","volume":"10","author":"Richter","year":"2021","journal-title":"J Clin Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1093\/ejcts\/ezx244","article-title":"Standardized definitions of structural deterioration and valve failure in assessing long-term durability of transcatheter and surgical aortic bioprosthetic valves: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) endorsed by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"52","author":"Capodanno","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1016\/j.jcin.2024.09.039","article-title":"Hemodynamic valve deterioration after transcatheter aortic valve replacement","volume":"18","author":"Alaour","year":"2025","journal-title":"JACC Cardiovasc Interv"},{"key":"B19","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1001\/jamacardio.2022.2222","article-title":"Association between early left ventricular ejection fraction improvement after transcatheter aortic valve replacement and 5-year clinical outcomes","volume":"7","author":"Kolte","year":"2022","journal-title":"JAMA Cardiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"020","DOI":"10.31083\/j.rcm2301020","article-title":"Evaluation of systemic inflammation in response to remote ischemic preconditioning in patients undergoing transcatheter aortic valve replacement (TAVR)","volume":"23","author":"Zhang","year":"2022","journal-title":"Rev Cardiovasc Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2685","DOI":"10.1016\/j.jcin.2025.09.023","article-title":"The inflammatory response to transcatheter aortic valve replacement","volume":"18","author":"Maznyczka","year":"2025","journal-title":"JACC Cardiovasc Interv"},{"key":"B22","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1186\/s12933-024-02414-9","article-title":"Prognostic effect of the TyG index on patients with severe aortic stenosis following transcatheter aortic valve replacement: a retrospective cohort study","volume":"23","author":"Li","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2717","DOI":"10.1016\/j.jacc.2021.02.038","article-title":"Valve academic research consortium 3: updated endpoint definitions for aortic valve clinical research","volume":"77","author":"G\u00e9n\u00e9reux","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1016\/j.jacc.2017.06.024","article-title":"Frailty in older adults undergoing aortic valve replacement","volume":"70","author":"Afilalo","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.jjcc.2018.11.013","article-title":"Prognostic value of objective nutritional status after transcatheter aortic valve replacement","volume":"73","author":"Honda","year":"2019","journal-title":"J Cardiol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1007\/s10238-024-01294-3","article-title":"The diagnostic role of the systemic inflammation index in patients with immunological diseases: a systematic review and meta-analysis","volume":"24","author":"Mangoni","year":"2024","journal-title":"Clin Exp Med"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1621209","DOI":"10.3389\/fimmu.2025.1621209","article-title":"Systemic immune-inflammation index as a versatile biomarker in autoimmune disorders: insights from rheumatoid arthritis, lupus, and spondyloarthritis","volume":"16","author":"Wu","year":"2025","journal-title":"Front Immunol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1177\/00033197221124778","article-title":"Statins and mortality of patients after transcatheter aortic valve implantation: a systematic review and meta-analysis","volume":"74","author":"Yarahmadi","year":"2023","journal-title":"Angiology"},{"key":"B29","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1186\/s12933-024-02504-8","article-title":"SGLT2-inhibitors In diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI)","volume":"23","author":"Paolisso","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"CJ-24-0265","DOI":"10.1253\/circj.CJ-24-0265","article-title":"Optimizing guideline-directed medical therapy during hospitalization improves prognosis in patients with worsening heart failure requiring readmissions","volume":"88","author":"Matsukawa","year":"2024","journal-title":"Circ J"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e20230467","DOI":"10.36660\/abc.20230467","article-title":"Tend\u00eancia temporal no implante percut\u00e2neo de biopr\u00f3tese a\u00f3rtica: an\u00e1lise de 10 anos do registro TAVIDOR","volume":"121","author":"Esteves","year":"2024","journal-title":"Arq Bras Cardiol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1912257\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:35:39Z","timestamp":1787636139000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2026.1912257\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":31,"alternative-id":["10.3389\/fcvm.2026.1912257"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2026.1912257","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]},"article-number":"1912257"}}