0081: Prevalence and determinants or right ventricular dysfunction in severe aortic stenosis

Abstract

systolic pulmonary artery pressure (sPAP) is a well known predictor of outcome in patients with valvular heart disease. In spite of this fact, limited data are available regarding the assessment of RV function in patients with aortic stenosis (AS). of this study is therefore to evaluate the prevalence and the determinants of RV dysfunction in severe AS patients 201 patients (mean age:79.7±8.7, male sex 55.5%) with severe AS underwent 2D echocardiography and speckle tracking echocardiography (STE) for the evaluation of left ventricular and RV function, aortic valve gradients and sPAP. A tricuspid annular plane systolic excursion (TAPSE) ≤17mm was used to define reduced RV ventricular function. RV function was impaired in 48 patients (24%). Patients with reduced TAPSE had an impaired LV ejection fraction (LVEF) (49.2±15.4 vs 57.9±10.9%, p<0.0001), significantly altered STE parameters (GLS: –10.3 ±3.9 vs –13.2±3.5%, GCS: –7.0±3. vs –10.4±4.9%, GRS: 18.7±11.6 vs 28.4±15.6, all p<0.001) and a higher sPAP (48.4±15.8 vs 40.9±12.7 mmHg, p=0.002) with respecto to patients with a normal RV function. Correlates of a reduced TAPSE were: LVEF (β=0.35, p<0.0001), LV global longitudinal, circumferential and radial strain (β=–0.40, β=–0.40, β=0.37 respectively, all p<0.0001), LV indexed stroke volume (β=0.44, s<0.0001), lnNT-proBNP (β=–0.51, p<0.0001) and sPAP (β=–0.27, p<0.0001). At Kaplan-Meier survival curve, a TAPSE ≤17mm was associated with a reduced survival in patients with AS (Log Rank test, p=0.034). In patients with severe AS, RV function impairment is frequent and is associated with a poor prognosis. The correlations of TAPSE highlight the RV-LV interdependence in AS patients. Further studies will clarify the real and independent prognostic value of RV function in severe AS patients and test for the RV reverse remodelling after treatment of the AS.