Abstract 20072: Prognostic Value of Baseline Right Ventricular Dysfunction in Patients Undergoing Transcatheter Aortic Valve Replacement
Introduction: The prevalence of right ventricular dysfunction (RVD) and its relationship with all-cause mortality in severe aortic stenosis patients treated with transcatheter aortic valve replacement (TAVR) is unknown.
Hypothesis: Presence of baseline RVD in patients treated with TAVR is associated with increased all-cause mortality.
Methods: We assessed RV function in 237 patients who underwent TAVR from July 2011 through July 2015. Tricuspid annular plane systolic excursion (TAPSE) was measured in the apical 4-chamber view. RVD is defined as TAPSE <16mm by guidelines. Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM), a well-validated composite score of >40 clinical parameters and risk factors, was calculated. Notably, the STS-PROM score does not account for RVD. Kaplan-Meier curves and Cox models were used to quantify the effect of RVD on mortality; the Akaike Information Criterion (AIC) was used to select the TAPSE threshold most strongly associated with all-cause mortality.
Results: Patients had median age 84 years, 50% were male, and had predominantly NYHA class ≥ III symptoms (72%) at presentation. Mean STS-PROM was 9.5 ± 5.1%, LVEF 52±14% and RV TAPSE were 17 ± 5mm. By AIC, TAPSE <15mm (28% of cohort) was the threshold most strongly associated with all-cause mortality. Three-year mortality post-TAVR was significantly higher in those with RV TAPSE<15mm (60% vs 31%, p=0.001). After adjusting for STS-PROM, TAPSE<15mm remained independently associated with all-cause mortality (HR=1.95, 95% CI 1.22-3.13, p=0.006) (Figure).
Conclusions: Right ventricular dysfunction is common in patients undergoing TAVR. Importantly, the presence of RVD (here identified as RV TAPSE<15 mm) is independently associated with all-cause mortality, even after adjusting for comprehensive STS-PROM. More data are needed to confirm the prognostic role of other RV functional parameters and whether interval changes might be linked with outcomes in these patients.
Author Disclosures: I. Abdelkarim: None. W. Han: None. F. Thoma: None. A.D. Althouse: None. W.E. Katz: None. F.W. Crock: None. M.E. Harinstein: None. D.E. Kliner: None. F. Navid: None. T.G. Gleason: None. J.S. Lee: None. J.T. Schindler: None. J.L. Cavalcante: None.
- © 2016 by American Heart Association, Inc.