Aortic stenosis (AS), a progressive valvular disease that results in increasing left ventricular (LV) afterload, leads to ventricular dysfunction and heart failure if left untreated. Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive and effective alternative to surgical replacement, especially in elderly or high-risk patients. Objectives: The present study aims to assess the influence of the tricuspid annular plane systolic excursion (TAPSE)/pulmonary systolic arterial pressure (PASP) ratio on clinical outcomes in patients with aortic stenosis undergoing TAVR and offer valuable insights into patient selection and tailored management strategies for individuals undergoing TAVR. Methods: A retrospective analysis was conducted on 100 patients with AS who underwent TAVR, included in two distinct groups based on their median TAPSE/PASP ratio. Results: Patients were divided according to their median TAPSE/PASP ratio into two groups. Those with lower TAPSE/PASP ratios had a higher incidence of post-procedural atrial fibrillation (AF) (48% vs. 28%, p = 0.0404), lower left-ventricular ejection fraction (LVEF) (41.06% vs. 49.50%, p < 0.0001), a more pronounced inflammatory and hematologic response, and longer hospitalization. Receiver-operating characteristic (ROC) analysis demonstrated modest but significant discrimination rather than high sensitivity or specificity for postprocedural arrhythmias, particularly atrial fibrillation. Conclusions: TAPSE/PASP should be regarded as a clinically useful risk-stratification marker in patients with AS undergoing TAVR, enabling the identification of high-risk patients and optimizing peri-procedural management.

AS, one of the most common forms of valvular heart disease, requiring intervention in aging populations in Europe and North America, has traditionally been viewed as a passive, degenerative condition. However, growing evidence supports a paradigm shift toward recognizing AS as an active metabolic and inflammatory disorder. This narrative review synthesizes experimental, translational, and clinical evidence published between 2015 and 2025 examining metabolic mechanisms linking valvular calcification and atrial remodeling in AS and discusses their clinical relevance in the context of transcatheter aortic valve replacement (TAVR). We discussed classical pathways involving mineral metabolism and vitamin signaling, alongside emerging roles of lipid oxidation, mitochondrial dysfunction, epigenetic regulation, and gut microbiome-derived metabolites. Further, metabolomic signatures associated with disease severity and post-TAVR outcomes were reviewed, highlighting the predominantly associative nature and current limitations of these data. Although valve replacement remains the only effective therapy for advanced AS, metabolic and multi-omics insights may improve future risk stratification and mechanistic understanding. Metabolomic profiling could be integrated at multiple points in the clinical pathway for aortic stenosis and TAVR—most promisingly for pre-procedural risk stratification. The present paper focuses on an integrative framework in which valvular calcification and atrial remodeling are viewed within a broader context of metabolic dysregulation. Future research should aim to translate molecular biomarkers into real-world diagnostics and targeted interventions.

Background: Severe aortic stenosis (AS) increases left ventricular afterload and disrupts ventricular–vascular coupling. Transcatheter aortic valve replacement (TAVR) promptly relieves valvular obstruction, but its immediate effects on blood pressure-dependent arterial load and ventricular–vascular interactions are not fully clarified. Estimated pulse wave velocity (ePWV), derived from age and mean arterial pressure, is a convenient surrogate of global arterial load. The study aimed to assess ePWV before and after TAVR and its relationship with ventricular function and inflammatory biomarkers. Methods: In this retrospective observational study, 100 elderly patients with severe AS undergoing TAVR underwent detailed clinical, laboratory, and echocardiographic assessments before and after the procedure. Arterial stiffness was quantified using ePWV, while left ventricular geometry and systolic function were evaluated by standard echocardiography. Post-procedural reassessment was performed at hospital discharge (median 8 days after TAVR). Results: TAVR led to a modest but significant reduction in ePWV (from 12.79 ± 1.54 to 12.39 ± 1.54 m/s, p < 0.01) and improvement in left ventricular ejection fraction (LVEF) (from 44.89 ± 9.2% to 46.7 ± 7.95%, p < 0.01). Higher baseline ePWV correlated with unfavorable left ventricular remodeling and systolic dysfunction, and post-procedural ePWV remained linked to right ventricular performance. Before TAVR, ePWV and LVEF were both associated with inflammatory biomarkers, relationships that disappeared after intervention. Conclusions: Overall, ePWV functioned as an integrated measure of ventricular–vascular interaction and global hemodynamic load, though its interpretation post-TAVR requires caution due to direct blood pressure dependence and confounding by acute procedural inflammation.

Objectives: This study aimed to investigate the associations between serum lipid biomarkers and pulse wave analysis (PWA) variables in patients at high and very high cardiovascular risk, with particular emphasis on age-related differences. Methods: Seventy-six patients at high or very high cardiovascular risk were enrolled and stratified into middle-aged (Group 1) and elderly (Group 2). All participants underwent PWA, and multiple serum lipid biomarkers were measured, including composite lipid indices. Results: In both age groups, PWA parameters showed significant correlations with serum lipid biomarkers. Systolic blood pressure (SBP) was an independent determinant of the lipid balance index (LBI), while pulse wave velocity (PWV) and SBP were independent determinants of the triglyceride–glucose (TyG) index. PWV correlated with age in both groups and was higher in Group 2 for comparable blood pressure values. In middle-aged patients, diastolic blood pressure (DBP) showed significant, independent associations with triglycerides and TyG, indicating a close link between peripheral vascular resistance and metabolic dysfunction in earlier stages of cardiovascular risk. In elderly patients, SBP and pulse pressure were predominantly associated with lipid-derived indices, reflecting the increasing contribution of large-artery stiffness and lipid-driven vascular remodeling with advancing age. Systematic Coronary Risk Estimation 2 (SCORE2) correlated significantly with PWV, the lipid index (LI), and the LBI. Conclusions: Serum lipid biomarkers and PWA-derived hemodynamic variables exhibit a significant, age-dependent interplay in patients with high and very high cardiovascular risk. These findings underscore the importance of age-specific evaluation of lipid–hemodynamic interactions to improve early identification and targeted management of high-risk individuals.