Abstract 18700: Right Ventricular Ejection Fraction Measured by Cardiovascular Magnetic Resonance Independently Predicts Mortality Following Transcatheter Aortic Valve Implantation
Introduction: Cardiovascular Magnetic Resonance (CMR) can provide important structural information in patients being considered for Transcatheter Aortic Valve Implantation (TAVI). However, the relationship between CMR measurements of ventricular function and long-term outcomes after TAVI has not previously been investigated.
Methods: 165 patients underwent 1.5T CMR prior to TAVI. Steady-state free precession sequences were used for aortic valve planimetry and to assess ventricular volumes and mass. Areas of gadolinium enhancement were assessed after injection of 0.1 mmol/kg of gadolinium contrast. Semi-automated image analysis was performed by two specialist reviewers blinded to patient treatment. Patient follow-up was obtained from the Office of National Statistics mortality database; mean follow-up time was 20.3 months (range 1-64 months).
Results: The mean age of the cohort was 78.5 years (SD +/-8.20), 47.4% were female. Mean left ventricular (LV) ejection fraction was 60.1% (SD +/-16.90), and mean right ventricular (RV) ejection fraction was 58.27% (SD +/-12.75).
On univariate analysis, age (Hazard ratio [HR] 1.053, P=0.022), diabetes (HR 3.010, P=0.001), pulmonary disease (HR 2.234, P=0.016), LV stroke volume (HR 0.979, P=0.003), RV stroke volume (HR 0.983, P=0.024), and RV ejection fraction (HR 0.973, P=0.030) were associated with mortality. On multivariate analysis, only age (HR 1.060, P=0.022), diabetes (HR 3.391, P<0.001), and RV ejection fraction (HR 0.969, P=0.015) associated independently with mortality.
Kaplan-Meier analysis revealed reduced cumulative survival among patients with impaired RV function (RVEF <50%, P=0.01; Figure).
Conclusions: Right ventricular ejection fraction, as measured on pre-procedural CMR, is an independent predictor of mortality following TAVI. CMR assessment of RV function may be important in the evaluation and risk stratification of patients undergoing TAVI.
Author Disclosures: A.C. Lindsay: None. T. Snow: None. R.J. Jabbour: None. S.K. Prasad: None. R.H. Mohiaddin: None. C. Di Mario: None. S.W. Davies: None. N.E. Moat: None.
- © 2014 by American Heart Association, Inc.