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, 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
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 [HRadj]: 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%; HRadj: 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 (HRadj: 2.16; 95% CI: 1.16 to 4.02), new RVD (HRadj: 3.93; 95% CI: 2.09 to 7.39), and maintained RVD (HRadj: 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.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed