Prognostic Value of Right Ventricular Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement

Asami, Masahiko; Stortecky, Stefan; Praz, Fabien; Lanz, Jonas; Räber, Lorenz; Franzone, Anna; Piccolo, Raffaele; Siontis, George C.M.; Heg, Dik; Valgimigli, Marco; Wenaweser, Peter; Roost, Eva; Windecker, Stephan; Pilgrim, Thomas

doi:10.1016/j.jcmg.2017.12.015

Cited by 97 publications

(56 citation statements)

References 20 publications

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“…20 −22 Data from the Swiss TAVI registry showed in 1,116 patients that RV dysfunction was present in 29.1% of the patients, defined by a tricuspid annulus plane systolic excursion <17 mm, a systolic velocity of the RV lateral wall <9.5 cm/s on tissue Doppler imaging, or a fractional area change <35%. 21 In addition, the presence of RV dysfunction was associated with a 2-fold increase in cardiovascular mortality after 1-year follow-up (20% vs 7%, adjusted hazard ratio = 2.94, 95% confidence interval: 2.02 to 4.27). 21 Of interest, recovery of RV function can be observed after TAVI in 57% of patients.…”

Section: Discussionmentioning

confidence: 92%

“…21 In addition, the presence of RV dysfunction was associated with a 2-fold increase in cardiovascular mortality after 1-year follow-up (20% vs 7%, adjusted hazard ratio = 2.94, 95% confidence interval: 2.02 to 4.27). 21 Of interest, recovery of RV function can be observed after TAVI in 57% of patients. However, the presence of persistent RV dysfunction was associated with increased 1year cardiovascular mortality (adjusted hazard ratio = 2.16, 95% confidence interval: 1.16 to 4.02).…”

Section: Discussionmentioning

confidence: 92%

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Comparison of the Usefulness of Strain Imaging by Echocardiography Versus Computed Tomography to Detect Right Ventricular Systolic Dysfunction in Patients With Significant Secondary Tricuspid Regurgitation

Hirasawa

Rosendael

Dietz

et al. 2020

The American Journal of Cardiology

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Assessment of right ventricular (RV) systolic function in patients with significant secondary tricuspid regurgitation (STR) remains challenging. In patients with severe aortic stenosis treated with transcatheter aortic valve implantation (TAVI), STR and RV enlargement have been associated with poor outcomes. In these patients, speckle tracking echocardiography (STE) may detect RV systolic dysfunction better than 3-dimensional (3D) RV ejection fraction (EF). The purpose of this study was to investigate the prevalence of RV dysfunction when assessed with STE in patients with significant STR (≥3+) compared with patients without significant STR (<3+) matched for 3D RV dimensions and RVEF on dynamic computed tomography (CT). Patients with dynamic CT data before TAVI were evaluated retrospectively. To assess the performance of RV-free wall strain (RVFWS) for identifying patients with impaired RV systolic function, patients were subsequently matched 1:1 based on age, gender, indexed RV end-diastolic volume (RVEDVi), indexed RV end-systolic volume (RVESVi), RVEF, and left ventricular ejection fraction (LVEF). In a total 267 patients (80 § 8 years, 48% male), significant STR (≥3+) was observed in 67 patients. Patients with STR≥3+ had larger RVEDVi, larger RVESVi, lower LVEF, and more impaired RVFWS compared with patients with STR<3+ (n = 200). After propensity score matching, patients with STR≥3+ (n = 53) had significantly more impaired RVFWS compared with patients with STR<3+ (n = 53): À18.2 § 5.0% versus À21.1 § 3.7%, p = 0.001. In conclusion, patients with significant STR have more pronounced RV systolic dysfunction as assessed with STE than the patients without significant STR despite having similar 3D RV dimensions and RVEF on dynamic CT.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Comparison of the Usefulness of Strain Imaging by Echocardiography Versus Computed Tomography to Detect Right Ventricular Systolic Dysfunction in Patients With Significant Secondary Tricuspid Regurgitation

Hirasawa

Rosendael

Dietz

et al. 2020

The American Journal of Cardiology

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“…Most of them rely on TAPSE or FAC with just two papers using a comprehensive echocardiographic evaluation or more advanced techniques. Asami et al 17 assessed RV function using TAPSE, FAC, and RV‐S`TDI and define RV dysfunction if >50% of the available RV function parameters were below the lower cutoff value, reporting a prevalence of RV dysfunction of 29.1%. Furthermore, in this study they found that patients with RV dysfunction had a lower left ventricular ejection fraction at baseline (45.1 ± 16.5% vs 56.6 ± 12.5%; P < .001) and a lower mean transvalvular gradient (39.8 ± 17.7 vs 45.5 ± 17.3 mm Hg; P < .001).…”

Section: Discussionmentioning

confidence: 99%

Right ventricle assessment in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

et al. 2020

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Introduction: Limited data are available regarding the evaluation of right ventricular (RV) performance in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Objective: To evaluate the prevalence of RV dysfunction in patients with severe AS undergoing TAVI and long-term changes. Methods: Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed: RV diameters, fractional area change, tricuspid annular plane systolic excursion (TAPSE), S-wave tissue Doppler of the tricuspid annulus (RV-S'TDI), global longitudinal strain (RV-GLS), and free wall strain (RV-FWS). Preprocedure and 1-year echo were analyzed.Results: Final population included 114 patients, mean age 83.63 ± 6.31 years, and 38.2% women. The prevalence of abnormal RV function was high, variable depending on the parameter that we analyzed, and it showed a significant reduction 1 year after TAVI implantation: 13.9% vs 6.8% (TAPSE < 17mm), P = .04; 26.3% vs 20% (fractional area change < 35%), P = .048; 41.2% vs 29.2% (RV-S'TDI < 9.5cm/s), P = .04; 48.7% vs 39.5% (RV-GLS > [20]), P = .049; and 48.7% vs 28.9% (RV-FWS > [20]), P = .03. Significant differences were noted between patients with low-flow (LF) vs normal-flow (NF) AS in RV dysfunction prevalence as well as in RV function recovery which is less evident in LF compared with NF patients. Conclusions: RV dysfunction is high among symptomatic AS patients undergoing TAVI, with variable prevalence depending on the echocardiographic parameter used. K E Y W O R D S pulmonary hypertension, right ventricle, right ventricle strain, severe aortic stenosis, TAVI | 587 PARDO SANZ et Al.

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“…Klappenersatzoperationen kann bereits heute für zukünftige interventionelle oder chirurgische Eingriffe an der TK abgeschätzt werden, dass die Prognose bei gleichzeitiger Behandlung einer LV-Klappenerkrankung und der damit verbundenen Reduktion der postkapillären Nachlast des RV besser ist als bei isolierten TK-Eingriffen. In neuester Zeit werden auch frühere Einzelerfahrungen bestätigt, dass sich bei einem Teil der betroffenen Patienten nach transkutaner Aortenklappenersatz-Intervention alle zuvor bestehenden Zeichen einer RH-Insuffizienz sogar ohne spezifische diesbezügliche Therapie rückbilden [20]. Grundsätzlich sind derzeit jedoch die Parameter bzw.…”

Section: Diagnostische Wertigkeit Der Echokardiografie Und Modulares unclassified

Rechtsherzdiagnostik

Fehske¹,

Quoc²,

Pfeiffer³

2020

Aktuel Kardiol

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ZusammenfassungDie differenzierte Diagnostik von Rechtsherzerkrankungen (Rechtsherz: RH) ist von zunehmender Bedeutung, da die entsprechenden Patienten klinisch erst spät symptomatisch werden, aber häufig eine hochgradige Form der Trikuspidalklappeninsuffizienz (TR) zugrunde liegt, die mittels neuer, teils katheterinterventioneller Therapiemöglichkeiten behandelt werden kann. Die Echokardiografie hat eine herausragende Bedeutung zur Erfassung der systolischen Funktion des rechten Ventrikels (RV), der TR und der spezifischen Zeichen der RH-Stauung. Dabei sind die Ergebnisse der Strainanalyse der freien Wand des RV und der 3-D-Analyse mit einzubeziehen. Die Hämodynamik einschließlich der Drücke im RV, rechten Vorhof (RA) und der Pulmonalarterie können abgeschätzt werden, sind aber durch die Auswirkungen der TR nicht in Absolutwerten zu bestimmen. Vor therapeutischen Entscheidungen sind ergänzend ein RH-Katheter und ggf. eine Magnetresonanztomografie (MRT) durchzuführen. In einem modularen System der RH-Insuffizienz sollten zukünftig prognoserelevante Parameter vor einer interventionellen oder chirurgischen Therapie festgelegt werden können.

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Prognostic Value of Right Ventricular Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement

Abstract: 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).

Cited by 97 publications

References 20 publications

Comparison of the Usefulness of Strain Imaging by Echocardiography Versus Computed Tomography to Detect Right Ventricular Systolic Dysfunction in Patients With Significant Secondary Tricuspid Regurgitation

Comparison of the Usefulness of Strain Imaging by Echocardiography Versus Computed Tomography to Detect Right Ventricular Systolic Dysfunction in Patients With Significant Secondary Tricuspid Regurgitation

Right ventricle assessment in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

Rechtsherzdiagnostik

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