Impact of right ventricular volumes on the outcomes of TAVR: A volumetric analysis of preprocedural computed tomography

Aims: The aim of this study was to assess the prognostic implications of increased right ventricle volume index (RVVI) using cardiac-gated computed tomography angiography (CCTA) data among patients undergoing transcatheter valve replacement (TAVR). Methods and results: CCTA of 323 patients who underwent TAVR at Stanford University Medical Center (CA, USA) and Tel Aviv Medical Center (Israel) between 2013 and 2016 was analysed by an automatic four-chamber volumetric software and grouped into quartiles according to RVVI. Higher one-year mortality rates were noted for the upper quartiles – 5%, 4.9%, 8.6%, and 16% (p=0.039), in Q1 <59 ml/m², Q2 59-69 ml/m², Q3 69-86 ml/m², and Q4 >86 ml/m², respectively. However, the differences were not significant after propensity score adjustments. Sub-analyses of Q1 demonstrated an escalating risk for one-year mortality in concordance to RVVI: HR 2.28, HR 2.76, and HR 4.7, for the upper 25^th, 15^th, and 5^th percentiles, respectively (p<0.05 for all comparisons). After propensity score adjustments for clinical and echocardiographic characteristics, only the upper 5^th percentiles (RVVI >120 ml/m²) retained statistical significance (HR 2.82, 95% CI: 1.02-7.78, p=0.045). Notably, 68.7% of patients from this group were considered low-intermediate risk for surgery. Conclusions: Cardiac volumetric data by CCTA performed for procedural planning may help to predict outcome in patients undergoing TAVR.