Right ventricular function and outcome in patients undergoing transcatheter aortic valve replacement. (30th December 2020)

• Record Type: Journal Article
• Authors: Koschutnik, Matthias; Dannenberg, Varius; Nitsche, Christian; Donà, Carolina; Siller-Matula, Jolanta M; Winter, Max-Paul; Andreas, Martin; Zafar, Amna; Bartko, Philipp E; Beitzke, Dietrich; Loewe, Christian; Aschauer, Stefan; Anvari-Pirsch, Anahit; Goliasch, Georg; Hengstenberg, Christian; Kammerlander, Andreas A; Mascherbauer, Julia
• Is Part Of: European heart journal. Volume 22:Number 11(2021)
• Page Start: 1295
• Page End: 1303
• Publication Date: 2020-12-30
• Subjects: RV function -- TAVR -- CMR -- echocardiography -- aortic stenosis -- outcome; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeaa342
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Aims: Right ventricular dysfunction (RVD) on echocardiography has been shown to predict outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). However, a comparison with the gold standard, RV ejection fraction (EF) on cardiovascular magnetic resonance (CMR), has never been performed. Methods and results: Consecutive patients scheduled for TAVR underwent echocardiography and CMR. RV fractional area change (FAC), tricuspid annular plane systolic excursion, RV free-lateral-wall tissue Doppler ( S '), and strain were assessed on echocardiography, and RVEF on CMR. Patients were prospectively followed. Adjusted regression analyses were used to report the strength of association per 1-SD decline for each RV function parameter with (i) N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, (ii) prolonged in-hospital stay (>14 days), and (iii) a composite of heart failure hospitalization and death. Two hundred and four patients (80.9 ± 6.6 y/o; 51% female; EuroSCORE-II: 6.3 ± 5.1%) were included. At a cross-sectional level, all RV function parameters were associated with NT-proBNP levels, but only FAC and RVEF were significantly associated with a prolonged in-hospital stay [adjusted odds ratio 1.86, 95% confidence interval (CI) 1.07–3.21; P = 0.027 and 2.29, 95% CI 1.43–3.67; P = 0.001, respectively]. A total of 56 events occurred during follow-up (mean 13.7 ± 9.5 months). After adjustment for the EuroSCORE-II, only RVEF was significantly associated with the composite endpoint (adjusted hazard ratio 1.70, 95% CI 1.32–2.20; P < 0.001). Conclusion: RVD as defined by echocardiography is associated with an advanced disease state but fails to predict outcomes after adjustment for pre-existing clinical risk factors in TAVR patients. In contrast, RVEF on CMR is independently associated with heart failure hospitalization and death.