Right heart echocardiographic parameters and outcomes of patients with aortic stenosis after transcatheter aortic valve implantation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The impact of right ventricular (RV) function and RV to pulmonary artery (RV-PA) coupling on outcomes of patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), and the early effect of the intervention, remain partly unclear. Aim To evaluate the impact of right heart echocardiographic (echo) parameters on the outcome of patients undergoing TAVI. Methods Retrospective analysis including consecutive patients submitted to TAVI at our center between 2007–2021. Pre and postprocedural (≤96h) echo parameters were analyzed: tricuspid annular plane systolic excursion (TAPSE), S-wave tissue Doppler velocity of the tricuspid annulus (S'), pulmonary arterial systolic pressure (PASP). TAPSE/PASP ratio was used as a surrogate of RV-PA coupling; TAPSE/PASP ratio<0.31 defined RV uncoupling. Primary endpoint (PE) was defined as all-cause death within 1-year after TAVI. Echo parameters were compared between patients according to the PE. Pairwise comparison of pre- and post-TAVI indexes was also performed, for the overall cohort and according to the primary endpoint. Statistical significance was considered if p<0.05. Results Of 1040 TAVI patients, 615 patients with complete echo data were included: median age 81 years, 53% female, left ventricular ejection fraction 55(45–60)%. Before TAVI, 60 patients (11%) presented RV dysfunction (TAPSE<17mm), and 30 (15%) RV-PA uncoupling. A significant reduction in PASP was observed after TAVI (40 vs 36 mmHg, p<0.01).[image] TAPSE decreased post-TAVI (20.0 vs 19.5 mm, p = 0.04); S’ values did not differ between evaluations (11.20 vs 11.50, p = 0.08). 1-year follow up data was available for 467 patients; the primary endpoint occurred in 37 (7.9%) patients. Patients meeting the PE had higher preprocedural PASP (42 vs 39 mmHg, p = 0.036). PASP decreased after TAVI (39 vs 36 mmHg, p<0.001) in patients who survived the 1st year, but not in patients meeting the PE (p = 0.82). Postprocedural TAPSE/PASP ratio was lower in the deceased group (0.43 vs 0.57, p = .031); persistence of RV-PA uncoupling post-TAVI was more frequent in patients who met the PE (25% vs 8.1%, p = .047). Conclusions In this cohort, RV longitudinal function parameters did not improve after TAVI. Contrastingly, RV-PA coupling improved after the procedure. Persistence of RV-PA uncoupling after TAVI was more frequent in patients who died during the 1st year of follow-up.