Abstract
Background: Right ventricular (RV) function predicts survival in numerous cardiac conditions, including left heart disease. The reference standard for non-invasive assessment of RV function is cardiac magnetic resonance imaging (CMR). The aim of this study was to investigate the association between pre-procedural CMR-derived RV functional parameters and mortality in patients undergoing transcatheter aortic valve implantation (TAVI).Methods: Patients scheduled for TAVI were recruited to undergo pre-procedural CMR. Volumetric function and global longitudinal and circumferential strain (GLS and GCS) of the RV and left ventricle (LV) were measured. The association with the primary endpoint (1-year all-cause mortality) was analyzed with Cox regression.Results: Of 133 patients undergoing CMR, 113 patients were included in the analysis. Mean age was 81.8 ± 5.8 years, and 65% were female. Median follow-up was 3.9 [IQR 2.3–4.7] years. All-cause and cardiovascular mortality was 14 and 12% at 1 year, and 28 and 20% at 3 years, respectively. One-year all-cause mortality was significantly predicted by RV GLS [HR = 1.109 (95% CI: 1.023–1.203); p = 0.012], RV ejection fraction [HR = 0.956 (95% CI: 0.929–0.985); p = 0.003], RV end-diastolic volume index [HR = 1.009 (95% CI: 1.001–1.018); p = 0.025], and RV end-systolic volume index [HR = 1.010 (95% CI: 1.003–1.017); p = 0.005]. In receiver operating characteristic (ROC) analysis for 1-year all-cause mortality, the area under the curve was 0.705 (RV GLS) and 0.673 (RV EF). Associations decreased in strength at longer follow-up. None of the LV parameters was associated with mortality.Conclusions: RV function predicts intermediate-term mortality in TAVI patients while LV parameters were not associated with outcomes. Inclusion of easily obtainable RV GLS may improve future risk scores.
Highlights
Transcatheter aortic valve implantation (TAVI) is a minimally invasive treatment for patients suffering from severe aortic stenosis and is available for more than a decade
This study aims to elucidate the association between preprocedural right ventricle (RV) functional parameters derived from cardiac magnetic resonance imaging (CMR) and mortality in patients undergoing TAVI
In this single-center cohort study, patients with severe aortic stenosis scheduled for TAVI at the Division of Cardiology, Medical University of Graz were prospectively recruited to undergo pre-procedural CMR between May 2011 and March 2015, in the absence of CMR contraindications
Summary
Transcatheter aortic valve implantation (TAVI) is a minimally invasive treatment for patients suffering from severe aortic stenosis and is available for more than a decade. Emerging evidence shows that the RV plays a key role in many cardiac conditions, including primary left heart disease [6]. Echocardiographic studies indicate that RV dysfunction is frequent in patients with severe aortic stenosis and is associated with mortality [12,13,14,15]. Right ventricular (RV) function predicts survival in numerous cardiac conditions, including left heart disease. The aim of this study was to investigate the association between pre-procedural CMR-derived RV functional parameters and mortality in patients undergoing transcatheter aortic valve implantation (TAVI)
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