Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 6, December 2026, pages 630-641

Association Between Changes in Paravalvular Leakage After Transcatheter Aortic Valve Implantation and Serum Lactate Dehydrogenase

↓ Figure 2. Changes in LDH levels before TAVI and 1 day, 3 days, 7 days, and 1 month after TAVI. LDH: lactate dehydrogenase; PVL: paravalvular leakage; TAVI: transcatheter aortic valve implantation.

↓ Figure 3. Severity of serum LDH elevation. LDH: lactate dehydrogenase; PVL: paravalvular leakage; TAVI: transcatheter aortic valve implantation.

↓ Figure 4. Changes in PVL severity after TAVI. PVL: paravalvular leakage; TAVI: transcatheter aortic valve implantation.

↓ Figure 5. ROC curve for predicting paravalvular leakage deterioration using the sizing index. The area under the ROC curve was 0.84, with an optimal cut-off value of 96.5% (odds ratio: 13.6; 95% confidence interval: 6.55–31.1; P < 0.01). ROC: receiver operating characteristic.

↓ **Table 1.** Baseline Patient Characteristics
	Overall	PVL deterioration group	Non-PVL deterioration group	P value
Values are mean ± standard deviation or n (%), unless otherwise specified. AR: aortic regurgitation; BSA: body surface area; LVEF: left ventricular ejection fraction; LCC: left-coronary cusp; LVOT: left ventricular outflow tract; MR: mitral valve regurgitation; NCC: non-coronary cusp; NYHA: New York Heart Association classification; PVL: paravalvular leakage; RCC: right-coronary cusp.
Number of patients	313	51	262
Age, years	84.3 ± 5.0	84.2 ± 5.3	84.4 ± 4.9	0.81
Age ≥ 85 years	151 (48.2)	23 (45.1)	128 (48.9)	0.62
Men	130 (41.5)	20 (39.2)	110 (42.0)	0.71
BSA, m²	1.53 ± 0.18	1.55 ± 0.18	1.52 ± 0.18	0.39
NYHA			-	0.08
I/II	242 (77.3)	44 (86.3)	198 (75.6)
III/IV	71 (22.7)	7 (13.7)	64 (24.3)
Society of Thoracic Surgeons risk score	7.4 ± 5.5	7.0 ± 4.3	7.4 ± 5.7	0.59
Hypertension	254 (81.2)	47 (92.2)	207 (79.0)	0.02
Diabetes mellitus	87 (27.8)	16 (31.4)	71 (27.1)	0.54
Dyslipidemia	122 (39.0)	21 (41.2)	101 (38.6)	0.73
Heart failure hospitalization	153 (48.9)	24 (47.1)	129 (49.2)	0.78
Echocardiographic parameters
LVEF, %	58.8 ± 12.5	61.0 ± 11.3	58.4 ± 12.7	0.18
Mean aortic gradient, mm Hg	45.8 ± 13.0	45.9 ± 14.2	45.8 ± 12.8	0.95
Aortic valve area, cm²	0.74 ± 0.22	0.77 ± 0.17	0.73 ± 0.23	0.31
AR ≥ mild	177 (56.6)	36 (70.6)	141 (53.8)	0.02
AR ≥ moderate	41 (13.1)	7 (13.7)	34 (13.0)	0.89
MR ≥ moderate	61 (19.5)	6 (11.8)	55 (21.0)	0.11
Computed tomography parameters
Annulus area, mm²	452 ± 82	453 ± 78	451 ± 82	0.88
Annulus perimeter, mm	75.6 ± 6.9	74.1 ± 6.4	75.9 ± 7.0	0.09
LVOT calc ≥ moderate	17 (5.4)	6 (11.8)	11 (4.2)	0.048
Calcium score	1,480 ± 308	1,769 ± 360	1,425 ± 263	< 0.01
LCC calcium score	451 ± 107	505 ± 127	404 ± 95	< 0.01
NCC calcium score	605 ± 121	707 ± 147	585 ± 105	< 0.01
RCC calcium score	455 ± 120	557 ± 147	435 ± 103	< 0.01
Bicuspid valve	17 (5.4)	6 (11.8)	11 (4.2)	0.048

↓ Table 1. Baseline Patient Characteristics

Overall

PVL deterioration group

Non-PVL deterioration group

P value

Values are mean ± standard deviation or n (%), unless otherwise specified. AR: aortic regurgitation; BSA: body surface area; LVEF: left ventricular ejection fraction; LCC: left-coronary cusp; LVOT: left ventricular outflow tract; MR: mitral valve regurgitation; NCC: non-coronary cusp; NYHA: New York Heart Association classification; PVL: paravalvular leakage; RCC: right-coronary cusp.

Number of patients

313

262

Age, years

84.3 ± 5.0

84.2 ± 5.3

84.4 ± 4.9

0.81

Age ≥ 85 years

151 (48.2)

23 (45.1)

128 (48.9)

0.62

Men

130 (41.5)

20 (39.2)

110 (42.0)

0.71

BSA, m²

1.53 ± 0.18

1.55 ± 0.18

1.52 ± 0.18

0.39

NYHA

0.08

I/II

242 (77.3)

44 (86.3)

198 (75.6)

III/IV

71 (22.7)

7 (13.7)

64 (24.3)

Society of Thoracic Surgeons risk score

7.4 ± 5.5

7.0 ± 4.3

7.4 ± 5.7

0.59

Hypertension

254 (81.2)

47 (92.2)

207 (79.0)

0.02

Diabetes mellitus

87 (27.8)

16 (31.4)

71 (27.1)

0.54

Dyslipidemia

122 (39.0)

21 (41.2)

101 (38.6)

0.73

Heart failure hospitalization

153 (48.9)

24 (47.1)

129 (49.2)

0.78

Echocardiographic parameters

LVEF, %

58.8 ± 12.5

61.0 ± 11.3

58.4 ± 12.7

0.18

Mean aortic gradient, mm Hg

45.8 ± 13.0

45.9 ± 14.2

45.8 ± 12.8

0.95

Aortic valve area, cm²

0.74 ± 0.22

0.77 ± 0.17

0.73 ± 0.23

0.31

AR ≥ mild

177 (56.6)

36 (70.6)

141 (53.8)

0.02

AR ≥ moderate

41 (13.1)

7 (13.7)

34 (13.0)

0.89

MR ≥ moderate

61 (19.5)

6 (11.8)

55 (21.0)

0.11

Computed tomography parameters

Annulus area, mm²

452 ± 82

453 ± 78

451 ± 82

0.88

Annulus perimeter, mm

75.6 ± 6.9

74.1 ± 6.4

75.9 ± 7.0

0.09

LVOT calc ≥ moderate

17 (5.4)

6 (11.8)

11 (4.2)

0.048

Calcium score

1,480 ± 308

1,769 ± 360

1,425 ± 263

< 0.01

LCC calcium score

451 ± 107

505 ± 127

404 ± 95

< 0.01

NCC calcium score

605 ± 121

707 ± 147

585 ± 105

< 0.01

RCC calcium score

455 ± 120

557 ± 147

435 ± 103

< 0.01

Bicuspid valve

17 (5.4)

6 (11.8)

11 (4.2)

0.048

↓ **Table 2.** Procedural Outcomes
	Overall	PVL deterioration group	Non-PVL deterioration group	P value
Values are mean ± SD or the median (IQR: 25th–75th percentile), or n (%), unless otherwise specified. EOA: effective orifice area; PPM: prosthesis–patient mismatch; PVL: paravalvular leakage; SD: standard deviation; IQR: interquartile range.
Number of patients	313	51	262
Fluoroscopy time, min	17.9 ± 7.5	16.8 ± 6.0	18.1 ± 7.7	0.25
General anesthesia	251 (80.2)	45 (88.2)	206 (78.6)	0.1
Anesthesia time, min	118 ± 50	107 ± 31	120 ± 53	0.09
Contrast volume, mL	39 ± 20	35 ± 20	40 ± 20	0.12
Blood transfusion	17 (5.4)	3 (5.9)	14 (5.3)	0.87
Transfemoral	270 (86.3)	48 (94.1)	222 (84.7)	0.052
Valve				< 0.01
SAPIEN 3	233 (74.4)	24 (47.1)	209 (79.8)
SAPIEN 3 Ultra RESILIA	80 (25.6)	27 (52.9)	53 (20.2)
Valve size				< 0.01
20 mm	16 (5.1)	3 (5.9)	13 (5.0)
23 mm	170 (54.3)	34 (66.7)	136 (51.9)
26 mm	103 (32.9)	11 (21.6)	92 (35.1)
29 mm	24 (7.7)	3 (5.9)	21 (8.0)
Under volume	204 (65.2)	36 (70.6)	168 (64.1)	0.37
Sizing index	97.8 ± 5.5	93.2 ± 3.9	98.6 ± 5.4	< 0.01
Balloon pre-dilation	155 (49.4)	19 (37.3)	136 (51.7)	0.06
Balloon post-dilation	30 (9.6)	1 (2.0)	29 (11.1)	0.02
Conversion to open heart surgery	0 (0)	0 (0)	0 (0)
Vascular complications
Minor	1 (0.3)	0 (0)	1 (0.4)	0.55
Major	11 (3.5)	2 (3.9)	9 (3.4)	0.86
Pacemaker implantation	9 (3.0)	1 (2.2)	8 (3.2)	0.7
Hemodynamic support needed	0 (0)	0 (0)	0 (0)
Paravalvular leakage
≥ mild	43 (13.7)	2 (3.9)	41 (15.7)	0.01
≥ moderate	2 (0.6)	0 (0)	2 (0.8)	0.4
Postprocedural mean aortic gradient, mm Hg	11.3 ± 3.8	10.9 ± 3.9	11.4 ± 3.8	0.37
Length of hospital stay, days	7.8 (6.7–8.9)	7.6 (6.5–8.4)	7.9 (6.8–9.2)	0.67
EOA, cm²	1.92 ± 0.56	1.94 ± 0.61	1.92 ± 0.55	0.88
Indexed EOA, cm²/m²	1.27 ± 0.36	1.26 ± 0.39	1.27 ± 0.35	0.84
PPM
≥ moderate	20 (6.4)	4 (7.8)	16 (6.1)	0.65
≥ severe	1 (0.3)	1 (2.0)	0 (0)	0.55
Clinically relevant hemolysis	2 (0.6)	2 (3.9)	0 (0)	< 0.01

↓ Table 2. Procedural Outcomes

Overall

PVL deterioration group

Non-PVL deterioration group

P value

Values are mean ± SD or the median (IQR: 25th–75th percentile), or n (%), unless otherwise specified. EOA: effective orifice area; PPM: prosthesis–patient mismatch; PVL: paravalvular leakage; SD: standard deviation; IQR: interquartile range.

Number of patients

313

262

Fluoroscopy time, min

17.9 ± 7.5

16.8 ± 6.0

18.1 ± 7.7

0.25

General anesthesia

251 (80.2)

45 (88.2)

206 (78.6)

0.1

Anesthesia time, min

118 ± 50

107 ± 31

120 ± 53

0.09

Contrast volume, mL

39 ± 20

35 ± 20

40 ± 20

0.12

Blood transfusion

17 (5.4)

3 (5.9)

14 (5.3)

0.87

Transfemoral

270 (86.3)

48 (94.1)

222 (84.7)

0.052

Valve

< 0.01

SAPIEN 3

233 (74.4)

24 (47.1)

209 (79.8)

SAPIEN 3 Ultra RESILIA

80 (25.6)

27 (52.9)

53 (20.2)

Valve size

< 0.01

20 mm

16 (5.1)

3 (5.9)

13 (5.0)

23 mm

170 (54.3)

34 (66.7)

136 (51.9)

26 mm

103 (32.9)

11 (21.6)

92 (35.1)

29 mm

24 (7.7)

3 (5.9)

21 (8.0)

Under volume

204 (65.2)

36 (70.6)

168 (64.1)

0.37

Sizing index

97.8 ± 5.5

93.2 ± 3.9

98.6 ± 5.4

< 0.01

Balloon pre-dilation

155 (49.4)

19 (37.3)

136 (51.7)

0.06

Balloon post-dilation

30 (9.6)

1 (2.0)

29 (11.1)

0.02

Conversion to open heart surgery

0 (0)

Vascular complications

Minor

1 (0.3)

0 (0)

1 (0.4)

0.55

Major

11 (3.5)

2 (3.9)

9 (3.4)

0.86

Pacemaker implantation

9 (3.0)

1 (2.2)

8 (3.2)

0.7

Hemodynamic support needed

0 (0)

Paravalvular leakage

≥ mild

43 (13.7)

2 (3.9)

41 (15.7)

0.01

≥ moderate

2 (0.6)

0 (0)

2 (0.8)

0.4

Postprocedural mean aortic gradient, mm Hg

11.3 ± 3.8

10.9 ± 3.9

11.4 ± 3.8

0.37

Length of hospital stay, days

7.8 (6.7–8.9)

7.6 (6.5–8.4)

7.9 (6.8–9.2)

0.67

EOA, cm²

1.92 ± 0.56

1.94 ± 0.61

1.92 ± 0.55

0.88

Indexed EOA, cm²/m²

1.27 ± 0.36

1.26 ± 0.39

1.27 ± 0.35

0.84

PPM

≥ moderate

20 (6.4)

4 (7.8)

16 (6.1)

0.65

≥ severe

1 (0.3)

1 (2.0)

0 (0)

0.55

Clinically relevant hemolysis

2 (0.6)

2 (3.9)

0 (0)

< 0.01

↓ **Table 3.** Predictors of PVL Deterioration in Univariable and Multivariable Logistic Regression Analyses
	Univariate analysis	Multivariate analysis
Values are mean ± standard deviation or n (%), unless otherwise specified. AR: aortic valve regurgitation; CI: confidence interval; LVOT: left ventricular outflow tract; OR: odds ratio; PVL: paravalvular leakage.
AR ≥ mild	2.04 (1.09–4.02)	0.03	1.82 (0.81–4.07)	0.15
LVOT calcium ≥ moderate	3.05 (1.01–8.46)	0.048	2.48 (0.59–10.4)	0.21
Aortic valve calcium score ≥ 1,435 (median)	8.29 (3.82–20.8)	< 0.01	6.54 (2.62–16.3)	< 0.01
SAPIEN 3 Ultra RESILIA	4.44 (2.37–8.36)	< 0.01	2.67 (1.19–6.01)	0.01
Post-dilatation	0.16 (0.01–0.78)	0.02	0.41 (0.04–3.95)	0.44
Sizing index < 96.5	13.6 (6.55–31.1)	< 0.01	10.5 (4.45–24.6)	< 0.01
Bicuspid valve	3.04 (1.08–8.55)	0.035

↓ Table 3. Predictors of PVL Deterioration in Univariable and Multivariable Logistic Regression Analyses

Univariate analysis

Multivariate analysis

OR (95% CI)

P value

OR (95% CI)

P value

Values are mean ± standard deviation or n (%), unless otherwise specified. AR: aortic valve regurgitation; CI: confidence interval; LVOT: left ventricular outflow tract; OR: odds ratio; PVL: paravalvular leakage.

AR ≥ mild

2.04 (1.09–4.02)

0.03

1.82 (0.81–4.07)

0.15

LVOT calcium ≥ moderate

3.05 (1.01–8.46)

0.048

2.48 (0.59–10.4)

0.21

Aortic valve calcium score ≥ 1,435 (median)

8.29 (3.82–20.8)

< 0.01

6.54 (2.62–16.3)

< 0.01

SAPIEN 3 Ultra RESILIA

4.44 (2.37–8.36)

< 0.01

2.67 (1.19–6.01)

0.01

Post-dilatation

0.16 (0.01–0.78)

0.02

0.41 (0.04–3.95)

0.44

Sizing index < 96.5

13.6 (6.55–31.1)

< 0.01

10.5 (4.45–24.6)

< 0.01

Bicuspid valve

3.04 (1.08–8.55)

0.035