Introduction

Patients with reduced left ventricular ejection fraction (LVEF) undergoing transcatheter aortic valve implantation (TAVI) represent a particularly vulnerable subgroup with elevated perioperative and long-term mortality. The neutrophil percentage-to-albumin ratio (NPAR), an integrated marker of systemic inflammation and nutritional status, has not been specifically evaluated as a prognostic marker in this population.

Aim

To examine the prognostic value of preprocedural NPAR for in-hospital and overall (all-cause) mortality in patients with reduced LVEF undergoing TAVI.

Material and methods

This retrospective single-centre study enrolled 169 consecutive patients with severe aortic stenosis and LVEF < 50% undergoing TAVI between June 2020 and January 2026. Preprocedural NPAR was derived from blood samples obtained within 24 h before the procedure. In-hospital and overall mortality were assessed using logistic and Cox regression models with limited covariate adjustment.

Results

Using an NPAR cut-off of 20.74, patients with elevated NPAR exhibited higher rates of chronic kidney disease, acute kidney injury, and both in-hospital and overall mortality, along with higher C-reactive protein and BNP levels and lower haemoglobin, albumin, postprocedural LVEF, and tricuspid annular plane systolic excursion (TAPSE) values. NPAR remained associated with in-hospital mortality after adjustment for chronic kidney disease or TAPSE and was also associated with overall mortality in multivariable Cox regression analyses. Kaplan–Meier analysis demonstrated significantly reduced survival among patients with elevated NPAR.

Conclusions

After limited multivariable adjustment, preprocedural NPAR was associated with both in-hospital and overall mortality in patients with reduced LVEF undergoing TAVI. As a simple marker of inflammatory and nutritional burden, NPAR may provide additional prognostic information and complement preprocedural risk assessment, although its incremental value beyond established risk models and other biomarkers remains uncertain.