Right ventricular systolic function in patients undergoing transcatheter aortic valve implantation: A systematic review and meta-analysis

Abstract

BackgroundRight ventricular (RV) systolic dysfunction is associated with worse survival in patients undergoing surgical aortic valve replacement (SAVR), yet it is not included in traditional risk scores of transcatheter aortic valve implantation (TAVI) candidates. We aimed to evaluate the prognostic value of RV systolic function on clinical outcomes in patients undergoing TAVI at one year follow-up; and, echocardiographic changes of RV systolic function up to 12 months after TAVI and compared with SAVR when possible. Methods and resultsThis systematic review and meta-analysis is registered in PROSPERO (CRD42017065761). Studies investigating RV systolic function with echocardiography in TAVI cohorts were identified from Medline, Embase and Cochrane databases. We used random-effects models to assess differences in primary outcomes. Twenty-one studies were identified, where RV systolic function and clinical outcomes were assessed in eight (4016 patients) and RV systolic function changes were evaluated in 14 (1709 patients). For the primary outcome of all-cause death at one year, RV systolic dysfunction was associated with a significant 78% relative risk increase (risk ratio[95% confidence interval (CI)]) = 1.78[1.37, 2.31], P < 0.01), albeit significant heterogeneity (I2 = 64%, P < 0.01). RV systolic function was unchanged after TAVI throughout follow-up as shown with tricuspid annular plane systolic excursion (TAPSE)(mean difference[95% CI]pre-discharge = 0.03 [−0.92,0.99]mm,1–3 months = −0.09[−0.89,0.71]mm,6–12 months = 0.52 [−0.29,1.32] mm, all P = NS), while TAPSE was significantly reduced after SAVR (pre-discharge = −10.17[−13.11,−7.24]mm, P < 0.01;1–3 months = −7.3[−8.17,−6.44]mm, P < 0.01;6–12 months = −5.99[−7.95,−4.03]mm, P < 0.01). ConclusionsRV systolic dysfunction was associated with a significant increase in all-cause mortality at one year after TAVI. RV systolic function was unchanged after TAVI up to 12 months, whereas deteriorated significantly after SAVR.