Right ventricular free wall longitudinal strain (RVFWSL) a new outcome predictor in patients candiate for TAVI

Abstract

Abstract Background Right ventricular (RV) systolic dysfunction is considered an outcome predictor in various cardiovascular diseases. RV dysfunction, assessed by RV free wall longitudinal strain (RVFWSL) in patients candidate for trans-catheter aortic valve implantation (TAVI), has not been extensively explored as an outcome predictor. Purpose Evaluate the prognostic value of pre intervention RVFWSL in patients undergoing TAVI. Methods Retrospective analysis of 100 patients who underwent transfemoral TAVI in our hospital from 2015 to 2019, with at least a pre and post-TAVI echocardiography. Clinical and echocardiographic data before and after TAVI and follow-up data were collected. We considered the value of [23.3]% the cut-off of normality for RVFWSL. The primary end-point was a composite of death from any cause and hospitalization for heart failure. Results The median age of the patients was 81 years (79–83) with a functional status NYHA II–III (81%) before the intervention. EF was preserved in most of the patients (median 56%, 55–58), while Right ventricle dysfunction assessed with RVFWLS was reduced in half of the patients at baseline. At a median follow-up of 1023 days (630–1387), the univariate analysis demonstrated a predictive value for a reduced RVFWSL (<[23.3]%, P=0.015) and EF<50% (P=0.014) before TAVI. Cox regression analysis found that pre-TAVI reduced RVFWSL (HR 2.875, 95% CI: 1.113–7.425; P=0.03) and EF <50% (HR 2.511, 95% CI: 1.07–5.892; P=0.03) were independently associated with composite end-point of the study. Moreover, a reduced EF associated with RVFWSL <[23.3]% showed an incremental value in predicting the outcome (P=0.021). Conclusions Among patients with severe aortic stenosis undergoing TAVI, a reduced pre-implant RVFWSL is able to predict long-term outcome. Funding Acknowledgement Type of funding sources: None.