Evolution of right ventricular dysfunction and tricuspid regurgitation after TAVI: A prospective study. (15th April 2022)

• Record Type: Journal Article
• Authors: Leclercq, Florence; Lorca, Laura; Agullo, Audrey; Bouchdoug, Karim; Macia, Jean-Christophe; Delseny, Delphine; Roubille, François; Gandet, Thomas; Lattuca, Benoit; Robert, Pierre; Schmutz, Laurent; Cayla, Guillaume; Duflos, Claire; Akodad, Mariama
• Is Part Of: International journal of cardiology. Volume 353(2022)
• Page Start: 29
• Page End: 34
• Publication Date: 2022-04-15
• Subjects: Aortic stenosis -- TAVI -- Right ventricular dysfunction -- Tricuspid regurgitation; AS Aortic Stenosis -- EDA End-Diastolic Area -- EROA Effective Regurgitant Orifice Area -- ESA End-Systolic Area -- EuroSCORE European System for Cardiac Operative Risk Evaluation -- FAC Fractional Area Change -- IVA Isovolumic Acceleration -- LVEF Left Ventricular Ejection Fraction -- PISA Proximal Isovelocity Surface Area -- RH Right Heart -- RV right ventricular -- R Vol Regurgitant Volume -- SAVR Surgical Aortic Valve Replacement -- sPAP Systolic Pulmonary Arterial Pressure -- TAPSE Tricuspid Annular Plane Systolic Excursion -- TAVI Transcatheter Aortic Valve Implantation -- TTE Transthoracic Echography; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.01.033
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Right ventricular (RV) dysfunction and tricuspid regurgitation (TR) may impact prognosis of patients undergoing Transcatheter Aortic Valve Implantation (TAVI). We aimed to evaluate the evolution of previous RV dysfunction and/or significant TR after TAVI procedure. Methods: All patients undergoing TAVI between January 2018 and January 2019 were enrolled in this prospective cohort. Patients with at least one right heart (RH) abnormality at baseline including RV dysfunction (TAPSE < 17 mm, S-wave < 9.5 cm/s, Fractional area change < 35%, Strain > −20%, Tei > 0.54) and/or significant TR (Effective Regurgitant Orifice Area ≥ 40 mm2 and/or Regurgitant Volume ≥ 45 mL) underwent transthoracic echocardiography at day 1 and 6-month after TAVI. The primary endpoint was the regression of pre-TAVI RV dysfunction and/or significant TR at 6-month follow-up. Results: The study enrolled 144 patients including 76 women (52.8%) with a mean age of 81.1 ± 6.8 yo, a mean EuroSCORE 2 of 5.2 ± 3.9%. At least one RH abnormality was observed in 53 patients (36.8%). At 6-month, at least one RV dysfunction parameter significantly improved in 26 patients (63.4%), TAPSE increasing from 13.0 ± 2.6 to 16.0 ± 9.8 mm, p < 0.0001 and S-wave from 7.7 ± 1.2 to 10.0 ± 2.6 cm/s, p = 0.004. Among 31 patients with baseline significant TR, TR decreased in 14 (45.2%); p = 0.003. Among patients with baseline RH abnormalities, 13 (24.5%) fully recovered. Baseline significant TR was predictive of 6-month clinical outcomes (OR = 3.1, 95%CI = [1.01–9.0], p = 0.03). Conclusion: In our recent intermediate surgical risk TAVI population, RV dysfunction and/or significant TR are frequent at baseline and fully or partially recover in most patients at 6-month follow-up. Highlights: RV dysfunction and significant TR are frequently observed prior TAVI and improve after the procedure in most of cases. RV dysfunction may be a decision-making parameter in favor of TAVI in patients with severe AS. Significant TR may not be, by itself, an argument for surgery as TR improves in most of patients following TAVI.