Impact of tricuspid annular shape on late worsening tricuspid regurgitation after transcatheter aortic implantation: insight from multidetector row computed tomography assessment

Abstract

Abstract Background Worsening of tricuspid regurgitation (TR) in patients undergoing transcatheter aortic valve implantation (TAVI) is associated with adverse clinical outcomes. The geometrical factors that determine the occurrence of significant TR after TAVI are uncertain. Multi-detector row computed tomography (MDCT) may provide additional geometrical insights in the pathophysiology of worsening TR after TAVI. Purpose To investigate the impact of right atrial and tricuspid annular (TA) geometryassessed by MDCT on the occurrence of significant TR (≥ moderate) at 1-year after TAVI. Methods Patients without significant TR who had undergone a full-beat MDCT prior to TAVI were included. Right and left atrial and ventricular volumes and TA parameters including the anterior-posterior (AP) and septal-lateral (SL) diameters, area and circularity (AP/SL ratio) were measured and correlated to the occurrence of significant TR at 1-year after TAVI. Results A total of 205 patients (80±7 years, 51% male) who underwent TAVI for severe aortic stenosiswere included. Moderate or severe TR at 1-year follow-up occurred in 59 patients (29%). Patients who developed significant TR were more likely to have atrial fibrillation and lower left ventricular (LV) volumes, but larger right and left atrial volumes and TA dimensions at baseline. After adjusting for atrial fibrillation and LV and right atrial volumes, larger end-diastolic TA SL diameter (odds-ratio 1.182 95% CI 1.047–1.334, P=0.007) and more circular TA shape were independently associated with the occurrence of significant TR. Conclusion In patients without significant TR prior to TAVI, TA dilation and loss of the elliptical shape of the TA at baseline are associated with of the occurrence of significant TR 1-year after TAVI. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ESC research grant 2018 Representative cases