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- Title
Right ventricular function and outcome in patients undergoing transcatheter aortic valve replacement.
- 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
- 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.
- Subjects
ECHOCARDIOGRAPHY; HEART valve prosthesis implantation; CONFIDENCE intervals; RIGHT heart ventricle; SURGERY; PATIENTS; MAGNETIC resonance imaging; REGRESSION analysis; TREATMENT effectiveness; DESCRIPTIVE statistics; HEART physiology; PEPTIDE hormones; HEART failure
- Publication
European Heart Journal - Cardiovascular Imaging, 2021, Vol 22, Issue 11, p1295
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jeaa342