Severe aortic stenosis and ischemic coronary artery disease are frequently associated in elderly patients, adding complexity to interventional management. Diastolic dysfunction, a marker of myocardial impairment and elevated filling pressures, may influence prognosis after transcatheter aortic valve implantation (TAVI), particularly in the presence of concomitant coronary pathology. The aim of the study was to analyze the interaction between severe aortic valve stenosis, left ventricular diastolic dysfunction, and coronary ischemia in elderly patients with complex cardiovascular disease.