Objective:

To evaluate the association of pressure-adjusted heart rate (PAHR) with survival in patients with severe aortic stenosis (AS).

Approach:

• Study Design: A retrospective cohort study of 14,409 adult patients with severe native aortic stenosis identified via transthoracic echocardiography from 2010 to 2020.
• PAHR Calculation: PAHR was calculated as heart rate × (right atrial pressure / mean arterial pressure) and patients were stratified into quartiles.
• Survival Analysis: Kaplan-Meier analyses and multivariable Cox proportional hazards models were used to assess the association between PAHR and all-cause mortality.

Key Findings:

• Higher PAHR quartiles were associated with progressively worse survival under medical management.
• Patients in the second, third, and fourth PAHR quartiles had 15%, 61%, and 151% higher adjusted risks of mortality compared to the lowest quartile.
• Baseline PAHR remained significantly associated with mortality following aortic valve replacement (AVR).
• Patients in the third and fourth PAHR quartiles had 34% and 89% higher adjusted risks of mortality post-AVR.

Interpretation:

PAHR may provide a simple, noninvasive estimate of overall hemodynamic burden in severe AS, offering complementary insight into patient risk before and after valve replacement.

Limitations:

• The study is retrospective and requires external validation.
• Prospective studies are needed to assess the incremental value of serial PAHR assessment.

Conclusion:

PAHR should be viewed as complementary to existing risk assessment approaches rather than a replacement.

Sources:

• ASE 2026 Late-Breaking Abstracts