Abstract: Objective: To explore the value of myocardial extracellular volume measured using dual-energy computed tomography (CT) in preoperative risk stratification for transcatheter aortic valve implantation (TAVI). Methods: We prospectively included 71 patients who underwent CT assessment before TAVI between June 2023 and June 2024, all of whom underwent dual-energy CT-delayed enhancement scans to calculate the ECV. Based on the median ECV, the patients were divided into high-ECV and low-ECV groups. The aim was to observe TAVI surgical outcomes and early postoperative recovery among the two patient groups. Results: The median ECV of the 71 patients was 33.92 ± 6.37%. Of these, 49 patients ultimately underwent TAVI surgery at our hospital, with 26 patients in the high-ECV group and 23 patients in the low-ECV group. The postoperative hospital stay, intensive care unit (ICU) stay, and incidence of cardiovascular adverse events were significantly greater in the high-ECV group than in the low-ECV group. Correlation analysis showed a positive correlation between ECV and the length of postoperative hospital stay (r=0.446, P=0.002). Multifactorial logistic regression analysis showed that ECV was an independent risk factor for short-term postoperative adverse cardiovascular events (OR=1.399, P=0.037). Conclusion: Cardiac ECV based on dual-energy CT has potential for preoperative risk stratification in patients with aortic valve disease undergoing TAVI.