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Transvalvular Flow Rate is Associated With Mortality Rate and Lifetime Loss in Aortic Valve Stenosis: A Meta-Analysis of Reconstructed Time-to-Event Data.

Michel Pompeu Sá·Christian Ken Fukunaga·Iago T C Grillo·Eric Katsuyama·Gabriel Oliveira Teixeira Lyra·Vitor Paiva de Almeida·Lucca M Lopes·Ricardo F O Suruagy-Motta·Federico Napoli·Antonio Polanco·Nicolas A Brozzi·Jose Navia
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Abstract

Low-flow states are associated with adverse outcomes in aortic stenosis (AS), but the prognostic value of transvalvular flow rate (TFR) has not been consistently established across studies. This study is a systematic review and meta-analysis of reconstructed time-to-event data was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses. PubMed/MEDLINE, EMBASE, and Cochrane Library were searched for studies (published by November 14, 2025) comparing low versus normal TFR in AS. Data were collected from Kaplan-Meier curves. The primary endpoint was all-cause mortality. Survival was assessed using pooled Kaplan-Meier curves, Cox regression, flexible parametric survival models, and restricted mean survival time (RMST) analysis. A total of 9 studies including 6,494 patients were analyzed; 2,575 (39.7%) had low TFR. At 8 years of follow-up, estimated survival was 34.1% (95% confidence interval [CI] 24.7% to 47%) in the low-TFR group and 63% (95% CI 58.9% to 67.4%) in the normal-TFR group. Low TFR was associated with higher all-cause mortality (hazard ratio 1.59, 95% CI 1.45 to 1.74, p < 0.001). We observed a progressively greater hazard over time, with the hazard ratio approaching 1.9 by 8 years. At 8 years, RMST in the normal-TFR group was 7.37 years (95% CI 7.21 to 7.53 years) versus 5.07 years (95% CI 4.91 to 5.23 years) in the low-TFR group, representing a lifetime loss of 2.3 years in the low-TFR group (&#x394;RMST -2.30 years, 95% CI -2.53 to -2.07 years, p < 0.001). In patients with AS, low TFR is associated with significantly higher mortality and lifetime loss. These findings support TFR as a clinically meaningful marker for risk stratification in AS.

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Aortic Valve StenosisHumansSurvival RateBlood Flow VelocityAortic ValvePrognosisaortic stenosismeta-analysistransvalvular flow rateJournal ArticleMeta-AnalysisSystematic Review

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Michel Pompeu S&#xe1;, Christian Ken Fukunaga, Iago T C Grillo, Eric Katsuyama, Gabriel Oliveira Teixeira Lyra, Vitor Paiva de Almeida, Lucca M Lopes, Ricardo F O Suruagy-Motta, Federico Napoli, Antonio Polanco, Nicolas A Brozzi, Jose Navia. 2026-08-03. Transvalvular Flow Rate is Associated With Mortality Rate and Lifetime Loss in Aortic Valve Stenosis: A Meta-Analysis of Reconstructed Time-to-Event Data.. https://doi.org/10.1016/j.amjcard.2026.07.024

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