Right ventricular ejection fraction assessed by computed tomography in patients undergoing transcatheter tricuspid valve intervention

Abstract

Background The role of right-ventricular (RV) function in patients with tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve interventions (TTVI) is poorly understood. Although cardiac computed tomography (CCT) provides elaborate three-dimensional (3D) visualization of the entire anatomy of the RV and theoretically allows to assess the global RV systolic function. Nevertheless, the utility of the functional assessments of the RV using CCT remains unclear in patients undergoing TTVI. Purpose This study investigated the association of right-ventricular ejection fraction (RVEF) assessed by CCT with clinical outcome in patients undergoing TTVI. Methods We retrospectively assessed 3D-RVEF by using pre-procedural CCT images in patients undergoing TTVI with either edge-to-edge repair or annuloplasty device. RV dysfunction (RVD) was defined as a CT-RVEF <45%. The primary outcome was a composite outcome, consisting of all-cause mortality and hospitalization due to heart failure, within one year after TTVI. Results Of 157 patients, 58 (36.9%) presented with CT-RVEF <45%. Patients with CT-RVEF <45% were more likely to be male, to have a previous history of coronary artery disease, and had higher EuroSCORE II and a lower LVEF compared to those with CT-RVEF ≥45%, while the severity of TR was comparable between the groups. Among the patients with CT-RVEF <45%, acute procedural success was achieved in 93.1%, and in-hospital mortality was 1.7%, which were comparable to those with CT-RVEF ≥45%. Patients with CT-RVEF <45% had an improvement in New York Heart Association functional class at follow-up compared to baseline; however, CT-RVEF <45% was associated with a higher risk of the composite outcome (adjusted hazard ratio: 3.23; 95% confidence interval: 1.52–6.88; p=0.002) (Figure 1). Furthermore, CT-RVEF had an additional value to stratify the risk of the composite outcome beyond two-dimensional transthoracic echocardiographic (TTE) assessments (Figure 2). In addition, patients with CT-RVEF <45% exhibited an attenuated association between a reduction in TR to <3+ and a lower incidence of the composite outcome after TTVI compared to those with CT-RVEF ≥45%. Conclusions TTVI is safe and feasible regardless of baseline RV function, while RVD, defined as 3D-RVEF <45%, is associated with a higher risk of the composite outcomes within one year after TTVI. Furthermore, our findings suggest that the prognostic benefits of TR reduction might be attenuated in patients with RVD. Given the additional prognostic value of CT-RVEF to the conventional echocardiographic assessments, the assessments of 3D-RVEF with CCT may refine the patient selection for TTVI. Funding Acknowledgement Type of funding sources: None.

Outcomes of Transcatheter Tricuspid Edge-to-Edge Repair in Patients With Right Ventricular Dysfunction

“…Also, 3-dimensional assessments using magnetic resonance imaging or computed tomography may provide more accurate information on the RV function. 27 Nonetheless, renal function or implanted pacemaker lead may limit their availability of imaging techniques or feasibility for measurements. The 3-dimensional-echocardiographic RV function (ie, RV ejection fraction and speckle tracking echocardiography) might be an alternative, 23,28 whereas the technical issues and imaging qualities are to be improved.…”

Changes in right ventricular function and clinical outcomes following tricuspid transcatheter edge‐to‐edge repair

“…The presence of RV dysfunction aggravates the clinical prognosis of patients with TR and limits therapeutic options for TR 3 . Although T‐TEER may safely reduce TR regardless of RV function, 6–8 treatment for TR patients with RV dysfunction remains still challenging. TR correction reduces the volume load of the right ventricle and can lead to recovery of RV function.…”

“…Moreover, RV dysfunction is related to an elevated risk of periprocedural adverse events after tricuspid valve surgery, 5 thereby limiting therapeutic options for TR. Recently developed transcatheter techniques might safely reduce TR regardless of RV function 6–8 ; however, long‐term prognosis is still poor in patients with RV dysfunction 7,9,10 . Thus, the treatment for TR patients with RV dysfunction remains challenging.…”