Abstract Body (Do not enter title and authors here): Background
Heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF) is a common comorbidity in patients undergoing transcatheter aortic valve replacement (TAVR). However, post-TAVR outcomes among HFpEF and HFrEF patients have not been well studied.
Objective
This study aims to investigate the clinical outcomes post-TAVR among patients with HFrEF vs. HFpEF.
Methods
The TriNeTX Global Collaborative Network research database was used to identify patients aged ≥18 years from January 2005 to May 2023. Patients were categorized into two groups: HFpEF and a control group with HFrEF, with both groups of patients undergoing TAVR and followed for 1-month and 1-year. Propensity score-matched analysis (PSM) (1:1) was performed on age, gender, race, body mass index, hypertension, diabetes mellitus, chronic kidney disease, smoking status, hemoglobin level, low density lipid (LDL) level, and various drugs including ACEi, ARBi, beta-blockers, SGLT2i and statins. Primary outcome was all-cause mortality (ACM), while secondary outcomes were acute myocardial infarction (AMI), ischemic stroke, hemorrhagic stroke, major bleeding and major adverse cardiovascular event (MACE) (composite of ACM, AMI and ischemic stroke).
Results
After 1:1 propensity score matching (Figure 1), the study cohort comprised of 11, 982 patients in HFpEF with TAVR and 11, 982 patients in the control group. The mean age of patients in HFpEF and HFrEF was 81.7 and 81.5 years, respectively. PSM analysis showed that post-TAVR outcomes among HFpEF patients were significantly associated with lower risk of ACM after 1-month (RR, 0.88 (95%CI: 0.707-0.953), P=0.009), and after 1-year (RR, 0.93 (95% CI: 0.87-0.99), P=0.041) compared with the HFrEF group. A similar trend was observed with a significant reduction in the risk of MACE after 1-month (RR, 0.86, (95% CI: 0.74-0.99), P=0.043), however, it was non-significant after 1-year (RR, 0.942 (95% CI: 0.881-1.007), P=0.077). However, the risk of AMI, ischemic stroke, hemorrhagic stroke, major bleeding both at 1-month and 1-year follow up were comparable between the HFpEF and HFrEF post-TAVR.

Conclusion
In patients with HFpEF post-TAVR, there was a significant decrease in ACM at 1-month and 1-year, while there was a significant reduction in MACE only at 1-month. Further investigation is warranted to determine whether HFpEF has better clinical outcomes than patients with HFrEF.