Diuretics are used to relieve congestive symptoms in patients with severe aortic stenosis (AS). However, the effect of preprocedural diuretic treatment on long-term outcomes in AS patients who undergoing transcatheter aortic valve implantation (TAVI) remains unclear. We prospectively enrolled 4,903 consecutive AS patients who underwent TAVI in 7 Japanese hospitals between April 2010 and June 2024 and evaluated the effect of preprocedural diuretics treatment on clinical outcomes. Patients were divided into 2 groups as follows: the Diuretics group, who received diuretic treatment before TAVI (n = 2,073), and the Non-Diuretics group without diuretic treatment (n = 2,830). The median observation period was 2.1 years. The Diuretics group was older and had higher surgical risk scores and more comorbidities, including prior myocardial infarction, atrial fibrillation/flutter, and peripheral artery disease. The Diuretics group included more patients with New York Heart Association (NYHA) classification III/IV, lower left ventricular ejection fraction, and reduced renal function. They had significantly worse all-cause and cardiovascular mortality than those in the Non-Diuretics group (38% versus 26% and 18% versus 10%, respectively; P < 0.001 by log-rank test). After propensity score matching to minimize the influence of confounding factors, preoperative diuretic treatment was associated with worse all-cause mortality (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.06-1.58, P = 0.012) and cardiovascular mortality (HR: 1.61, 95%CI: 1.15-2.26, P = 0.006). Two fifths of AS patients who undergoing TAVI received preoperative diuretics, and those patients had worse all-cause and cardiovascular mortality. Preprocedural diuretic treatment was an independent predictor of all-cause and cardiovascular mortality after TAVI.
Keywords: Aortic stenosis; Diuretics; Heart failure; Structural heart disease.