Impact of Right Ventricular Dysfunction and Tricuspid Regurgitation on Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

Lorin Arie Schwartz, Zach Rozenbaum, Ehab Ghantous, Judith Kramarz, Simon Biner, Michael Ghermezi, Jason Shimiaie, Ariel Finkelstein, Shmuel Banai, Galit Aviram, Meirav Ingbir, Gad Keren, Yan Topilsky

Research output: Contribution to journalArticlepeer-review

Abstract

Background Right ventricular (RV) dysfunction and tricuspid regurgitation (TR) may coexist with aortic stenosis. The aim of this study was to assess the association between RV dysfunction, TR, associated comorbidities, and outcomes following transcatheter aortic valve replacement (TAVR). Methods A retrospective analysis was conducted of baseline and 6-month clinical and echocardiographic parameters, including TR grade, RV size (grade, end-diastolic and end-systolic areas, annular diameter), and function (grade, tricuspid annular plane systolic excursion [TAPSE], fractional area change, Tei index), in 519 consecutive TAVR patients. Results The prevalence of moderate or greater TR was 11% (n = 59). Although TR was associated with increased mortality (P = .02) in unadjusted analysis, it did not demonstrate an independent association with outcome when adjusted for RV dysfunction (TAPSE; P = .30) or multiple clinical parameters (P ≥ .20). RV parameters associated with poor outcomes included TAPSE (P = .006) and Tei index (P = .005). TAPSE was associated with lower survival even when adjusted for TR (P = .009) and all clinical parameters (P = .01). Persistence of moderate or greater TR 6 months after TAVR seemed to be associated with lower survival (P = .02), even when adjusted for clinical and RV parameters (P = .07). Conclusions TR in association with aortic stenosis is frequently progressive despite TAVR but is not independently associated with outcomes. RV function is a stronger driver of adverse outcomes compared with TR itself, and RV quantitative rather than qualitative evaluation is the key to stratify these patients.

Original languageEnglish
Pages (from-to)36-46
Number of pages11
JournalJournal of the American Society of Echocardiography
Volume30
Issue number1
DOIs
StatePublished - 1 Jan 2017

Keywords

  • Aortic stenosis
  • Prognosis
  • Transcatheter aortic valve replacement
  • Tricuspid annular plane systolic excursion
  • Tricuspid regurgitation

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