Prognostic Value of Right Ventricular Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement

Masahiko Asami; Stefan Stortecky; Fabien Praz; Jonas Lanz; Lorenz Räber; Anna Franzone; Raffaele Piccolo; George C M Siontis; Dik Heg; Marco Valgimigli; Peter Wenaweser; Eva Roost; Stephan Windecker; Thomas Pilgrim

doi:10.1016/j.jcmg.2017.12.015

Prognostic Value of Right Ventricular Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement

JACC Cardiovasc Imaging. 2019 Apr;12(4):577-587. doi: 10.1016/j.jcmg.2017.12.015. Epub 2018 Feb 14.

Affiliations

¹ Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
² Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland.
³ Department of Cardiac Surgery, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland.
⁴ Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland. Electronic address: [email protected].

PMID: 29454762
DOI: 10.1016/j.jcmg.2017.12.015

Abstract

Objectives: The purpose of this study was to investigate the association between right ventricular dysfunction (RVD) and cardiovascular death after transcatheter aortic valve replacement (TAVR).

Background: There is conflicting evidence on the effect of RVD on clinical outcomes after TAVR.

Methods: A total of 1,116 TAVR patients (age 82 ± 6 years; 51% female) who were consecutively enrolled into a prospective registry underwent detailed pre-operative assessment of right ventricular (RV) function and were dichotomized into 2 groups for the purposes of the present retrospective analysis. RVD was assessed using fractional area change (<35%), tricuspid annular plane systolic excursion (<1.7 cm), and systolic movement of the RV lateral wall by tissue Doppler imaging (<9.5 cm/s). RVD was found in 325 (29.1%) patients. The primary outcome was cardiovascular death at 1 year.

Results: After adjustment for comorbidities, patients with RVD had a higher risk of cardiovascular death at 1 year compared with patients with normal RV function (20.1% vs. 7.1%; adjusted hazard ratio [HR_adj]: 2.94; 95% confidence interval [CI]: 2.02 to 4.27; p < 0.001). The difference emerged within the first 30 days after TAVR (9.0% vs. 2.2%; HR_adj: 4.62; 95% CI: 2.51 to 8.50; p < 0.001). Normalization of RV function after TAVR was found in 57.4% of patients with RVD at baseline. There was a gradient of increasing risk of cardiovascular death among patients with normal RV function, RVD recovery (HR_adj: 2.16; 95% CI: 1.16 to 4.02), new RVD (HR_adj: 3.93; 95% CI: 2.09 to 7.39), and maintained RVD (HR_adj: 8.74; 95% CI: 5.33 to 14.3), respectively.

Conclusions: RVD at baseline was associated with a more than 2-fold increased risk of cardiovascular death at 1 year after TAVR, with a gradient of risk according to RVD recovery. (Swiss TAVI Registry; NCT01368250).

Keywords: aortic stenosis; recovery of right ventricular function; right ventricular function; transcatheter aortic valve replacement.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Aortic Valve Stenosis / diagnostic imaging
Aortic Valve Stenosis / mortality
Aortic Valve Stenosis / physiopathology
Aortic Valve Stenosis / surgery*
Cause of Death
Comorbidity
Echocardiography, Doppler
Female
Humans
Male
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Transcatheter Aortic Valve Replacement* / adverse effects
Transcatheter Aortic Valve Replacement* / mortality
Treatment Outcome
Ventricular Dysfunction, Right / diagnostic imaging
Ventricular Dysfunction, Right / mortality
Ventricular Dysfunction, Right / physiopathology*
Ventricular Function, Right*

Associated data

ClinicalTrials.gov/NCT01368250