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, Georg C M; Heg, Dik; Valgimigli, Marco; Wenaweser, Peter; Roost, Eva; Windecker, Stephan; Pilgrim, Thomas (2019). Prognostic Value of Right Ventricular Dysfunction on Clinical Outcomes After Transcatheter Aortic Valve Replacement. JACC. Cardiovascular Interventions, 12(4), pp. 577-587. Elsevier 10.1016/j.jcmg.2017.12.015

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OBJECTIVES The purpose of this study was to investigate the association between right ventricular dysfunction (RVD) and cardiovascular death after transcatheter aortic valve replacement (TAVR). BACKGROUND There is conflicting evidence on the effect of RVD on clinical outcomes after TAVR. METHODS A total of 1,116 TAVR patients (age 82 ± 6 years; 51% female) who were consecutively enrolled into a prospective registry underwent detailed pre-operative assessment of right ventricular (RV) function and were dichotomized into 2 groups for the purposes of the present retrospective analysis. RVD was assessed using fractional area change (<35%), tricuspid annular plane systolic excursion (<1.7 cm), and systolic movement of the RV lateral wall by tissue Doppler imaging (<9.5 cm/s). RVD was found in 325 (29.1%) patients. The primary outcome was cardiovascular death at 1 year. RESULTS After adjustment for comorbidities, patients with RVD had a higher risk of cardiovascular death at 1 year compared with patients with normal RV function (20.1% vs. 7.1%; adjusted hazard ratio [HR]: 2.94; 95% confidence interval [CI]: 2.02 to 4.27; p < 0.001). The difference emerged within the first 30 days after TAVR (9.0% vs. 2.2%; HR: 4.62; 95% CI: 2.51 to 8.50; p < 0.001). Normalization of RV function after TAVR was found in 57.4% of patients with RVD at baseline. There was a gradient of increasing risk of cardiovascular death among patients with normal RV function, RVD recovery (HR: 2.16; 95% CI: 1.16 to 4.02), new RVD (HR: 3.93; 95% CI: 2.09 to 7.39), and maintained RVD (HR: 8.74; 95% CI: 5.33 to 14.3), respectively. CONCLUSIONS 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).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Asami, Masahiko; Stortecky, Stefan; Praz, Fabien; Lanz, Jonas; Räber, Lorenz; Franzone, Anna; Piccolo, Raffaele; Siontis, Georgios; Heg, Dierik Hans; Valgimigli, Marco; Wenaweser, Peter Martin; Roost, Eva; Windecker, Stephan and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

27 Feb 2018 14:40

Last Modified:

07 Apr 2019 01:30

Publisher DOI:

10.1016/j.jcmg.2017.12.015

PubMed ID:

29454762

Uncontrolled Keywords:

aortic stenosis recovery of right ventricular function right ventricular function transcatheter aortic valve replacement

BORIS DOI:

10.7892/boris.112035

URI:

https://boris.unibe.ch/id/eprint/112035

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