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.
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.
Authors: Ibrahim Sultan; Arturo Cardounel; Islam Abdelkarim; Arman Kilic; Andrew D Althouse; Michael S Sharbaugh; Aman Gupta; Jeff Xu; Miho Fukui; Marc A Simon; John T Schindler; Joon S Lee; Thomas G Gleason; João L Cavalcante Journal: Heart Date: 2018-08-09 Impact factor: 5.994
Authors: Ahmad Masri; Islam Abdelkarim; Michael S Sharbaugh; Andrew D Althouse; Jeffrey Xu; Wei Han; Stephen Y Chan; William E Katz; Frederick W Crock; Matthew E Harinstein; Dustin E Kliner; Forozan Navid; Joon S Lee; Thomas G Gleason; John T Schindler; João L Cavalcante Journal: Heart Date: 2017-09-29 Impact factor: 5.994
Authors: Didrik Kjønås; Gry Dahle; Henrik Schirmer; Siri Malm; Jo Eidet; Lars Aaberge; Terje Steigen; Svend Aakhus; Rolf Busund; Assami Rösner Journal: Open Heart Date: 2019-04-23
Authors: Philippe Généreux; Philippe Pibarot; Björn Redfors; Michael J Mack; Raj R Makkar; Wael A Jaber; Lars G Svensson; Samir Kapadia; E Murat Tuzcu; Vinod H Thourani; Vasilis Babaliaros; Howard C Herrmann; Wilson Y Szeto; David J Cohen; Brian R Lindman; Thomas McAndrew; Maria C Alu; Pamela S Douglas; Rebecca T Hahn; Susheel K Kodali; Craig R Smith; D Craig Miller; John G Webb; Martin B Leon Journal: Eur Heart J Date: 2017-12-01 Impact factor: 29.983