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Multicenter Study
. 2024 Nov 5;13(21):e036239.
doi: 10.1161/JAHA.124.036239. Epub 2024 Nov 4.

Prevalence and Prognostic Significance of Right Ventricular Dysfunction in Patients With Severe Low-Flow, Low-Gradient Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Michele Bellino  1 , Germano Junior Ferruzzi  1 , Arturo Giordano  2 , Tiziana Attisano  3 , Francesco Maiellaro  1 , Rodolfo Citro  4 , Cesare Baldi  3 , Nicola Corcione  2 , Alberto Morello  2 , Giovanni Granata  1 , Sara Turino  1 , Marco Di Maio  1   3 , Angelo Silverio  1 , Gennaro Galasso  1
Affiliations
Multicenter Study

Prevalence and Prognostic Significance of Right Ventricular Dysfunction in Patients With Severe Low-Flow, Low-Gradient Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Michele Bellino et al. J Am Heart Assoc. .

Abstract

Background: Whether the presence of right ventricular (RV) dysfunction may influence the clinical outcome of patients with low-flow, low-gradient aortic stenosis (LFLG-AS) undergoing transcatheter aortic valve replacement (TAVR) has not yet been established.

Methods and results: This study included consecutive patients with LFLG-AS undergoing TAVR at 2 high-volume Italian centers. RV dysfunction before TAVR procedure was defined as tricuspid annular plane systolic excursion assessed by transthoracic echocardiography lower than <17 mm. The primary outcome was all-cause death at 1 year. The propensity score weighting technique was implemented to account for potential selection bias between patients with and without RV dysfunction. A prespecified subgroup analysis was conducted to evaluate the consistency of the results in patients with classical and paradoxical LFLG-AS forms. This study included 392 patients; of them, 97 (24.7%) patients showed RV dysfunction before TAVR. At propensity score-weighted adjusted Cox regression analysis, RV dysfunction, according to dichotomous definition, was associated with an increased risk for the primary outcome (adjusted hazard ratio [HR], 3.11 [95% CI, 1.58-6.13]), cardiovascular death (adjusted HR, 3.26 [95% CI, 1.58-6.72]), and major adverse cardiovascular and cerebrovascular events (adjusted HR, 3.39 [95% CI, 1.76-6.53]). Conversely, no difference was detected for the risk of stroke and of permanent pacemaker implantation. No significant interaction of the classical and paradoxical LFLG-AS subgroups was detected for all the outcomes of interest.

Conclusions: This study suggests that RV dysfunction echocardiographically assessed by tricuspid annular plane systolic excursion may improve the prognostic stratification of patients with LFLG-AS undergoing TAVR.

Keywords: clinical outcome; right ventricular function; transcatheter aortic valve implantation.

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Figures

Figure 1
Figure 1. Survival free from the primary outcome according to the presence or absence of RV dysfunction before transcatheter aortic valve replacement.
RV indicates right ventricular; and RVD, right ventricular dysfunction.
Figure 2
Figure 2. Unadjusted (A) and adjusted (B) HR for the risk of the study outcomes at 1 year according to TAPSE values before TAVR.
HR indicates hazard ratio; MACCE, major adverse cardiovascular and cerebrovascular events (composite of all‐cause death, stroke, and myocardial infarction); PM, pacemaker; RV, right ventricular; TAPSE, tricuspid annular plane systolic excursion; and TAVR, transcatheter aortic valve replacement.
Figure 3
Figure 3. Adjusted HR for the study outcomes according to TAPSE (A) and to the presence of RV dysfunction (B) before TAVR in patients with paradoxical and classical LFLG‐AS.
HR indicates hazard ratio; LFLG‐AS, low‐flow, low‐gradient aortic stenosis; MACCE, major adverse cardiovascular and cerebrovascular events (composite of all‐cause death, stroke, and myocardial infarction); PM, pacemaker; RV, right ventricular; TAPSE, tricuspid annular plane systolic excursion; and TAVR, transcatheter aortic valve replacement.
See this image and copyright information in PMC

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