Right ventricle assessment in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation.

Abstract

Limited data are available regarding the evaluation of right ventricular (RV) performance in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). To evaluate the prevalence of RV dysfunction in patients with severe AS undergoing TAVI and long-term changes. Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed: RV diameters, fractional area change, tricuspid annular plane systolic excursion (TAPSE), S-wave tissue Doppler of the tricuspid annulus (RV-S'TDI), global longitudinal strain (RV-GLS), and free wall strain (RV-FWS). Preprocedure and 1-year echo were analyzed. Final population included 114 patients, mean age 83.63±6.31years, and 38.2% women. The prevalence of abnormal RV function was high, variable depending on the parameter that we analyzed, and it showed a significant reduction 1year after TAVI implantation: 13.9% vs 6.8% (TAPSE<17mm), P=.04; 26.3% vs 20% (fractional area change<35%), P=.048; 41.2% vs 29.2% (RV-S'TDI<9.5cm/s), P=.04; 48.7% vs 39.5% (RV-GLS>[20]), P=.049; and 48.7% vs 28.9% (RV-FWS>[20]), P=.03. Significant differences were noted between patients with low-flow (LF) vs normal-flow (NF) AS in RV dysfunction prevalence as well as in RV function recovery which is less evident in LF compared with NF patients. RV dysfunction is high among symptomatic AS patients undergoing TAVI, with variable prevalence depending on the echocardiographic parameter used.