Paul C Cremer1, Yiran Zhang2, Maria Alu3, L Leonardo Rodriguez1, Brian R Lindman4, Alan Zajarias5, Rebecca T Hahn3, Stamatios Lerakis6, S Chris Malaisrie7, Pamela S Douglas8, Philippe Pibarot9, Lars G Svensson10, Martin B Leon2,3, Wael A Jaber1. 1. Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave: DeskJ1-5, Cleveland, OH, USA. 2. Cardiovascular Research Foundation, New York, NY, USA. 3. Columbia University Medical Center, New York, NY, USA. 4. Vanderbilt University Medical Center, Nashville, TN, USA. 5. Washington University School of Medicine, St. Louis, MO, USA. 6. Emory University, Atlanta, GA, USA. 7. Northwestern University, Chicago, IL, USA. 8. Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA. 9. Department of Medicine, Université Laval, Quebec, Canada. 10. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
Abstract
Aims: In patients randomized to transcatheter or surgical aortic valve replacement (TAVR, SAVR), we sought to determine whether SAVR is associated with worsening right ventricular (RV) function and whether RV deterioration is associated with mortality. Methods and results: In 1376 patients from PARTNERIIA with paired baseline and 30-day core lab echocardiograms, worsening RV function was defined as decline by at least one grade from baseline to 30 days. Our primary outcome was all-cause mortality from 30 days to 2 years. Among 744 patients with TAVR, 62 (8.3%) had worsening RV function, compared with 156 of 632 patients with SAVR (24.7%) (P < 0.0001). In a multivariable model, SAVR [odds ratio (OR) 4.05, 95% confidence interval (CI) 2.55-6.44], a dilated RV (OR 2.38, 95% CI 1.37-4.14), and more than mild tricuspid regurgitation (TR) (OR 2.58, 95% CI 1.25-5.33) were associated with worsening RV function. There were 169 deaths, and patients with worsening RV function had higher all-cause mortality [hazard ratio (HR) 1.98, 95% CI 1.40-2.79]. This association remained robust after adjusting for clinical and echocardiographic variables. Among patients with worsening RV function, there was no mortality difference between TAVR and SAVR (HR 1.16, 95% CI 0.61-2.18). The development of moderate or severe RV dysfunction from baseline normal RV function conferred the worst prognosis (HR 2.87, 95% CI 1.40-5.89). Conclusion: After aortic valve replacement, worsening RV function is more common in patients with baseline RV dilation, more than mild TR, and in patients treated with SAVR. Worsening RV function and the magnitude of deterioration have important prognostic implications.
RCT Entities:
Aims: In patients randomized to transcatheter or surgical aortic valve replacement (TAVR, SAVR), we sought to determine whether SAVR is associated with worsening right ventricular (RV) function and whether RV deterioration is associated with mortality. Methods and results: In 1376 patients from PARTNERIIA with paired baseline and 30-day core lab echocardiograms, worsening RV function was defined as decline by at least one grade from baseline to 30 days. Our primary outcome was all-cause mortality from 30 days to 2 years. Among 744 patients with TAVR, 62 (8.3%) had worsening RV function, compared with 156 of 632 patients with SAVR (24.7%) (P < 0.0001). In a multivariable model, SAVR [odds ratio (OR) 4.05, 95% confidence interval (CI) 2.55-6.44], a dilated RV (OR 2.38, 95% CI 1.37-4.14), and more than mild tricuspid regurgitation (TR) (OR 2.58, 95% CI 1.25-5.33) were associated with worsening RV function. There were 169 deaths, and patients with worsening RV function had higher all-cause mortality [hazard ratio (HR) 1.98, 95% CI 1.40-2.79]. This association remained robust after adjusting for clinical and echocardiographic variables. Among patients with worsening RV function, there was no mortality difference between TAVR and SAVR (HR 1.16, 95% CI 0.61-2.18). The development of moderate or severe RV dysfunction from baseline normal RV function conferred the worst prognosis (HR 2.87, 95% CI 1.40-5.89). Conclusion: After aortic valve replacement, worsening RV function is more common in patients with baseline RV dilation, more than mild TR, and in patients treated with SAVR. Worsening RV function and the magnitude of deterioration have important prognostic implications.
Authors: Lars Grønlykke; André Korshin; Frederik Holmgaard; Sven Morten Kjøller; Finn Gustafsson; Jens Chr Nilsson; Hanne Berg Ravn Journal: Int J Cardiovasc Imaging Date: 2019-05-02 Impact factor: 2.357
Authors: Mark Lachmann; Elena Rippen; Tibor Schuster; Erion Xhepa; Moritz von Scheidt; Teresa Trenkwalder; Costanza Pellegrini; Tobias Rheude; Amelie Hesse; Anja Stundl; Gerhard Harmsen; Shinsuke Yuasa; Heribert Schunkert; Adnan Kastrati; Karl-Ludwig Laugwitz; Michael Joner; Christian Kupatt Journal: Open Heart Date: 2022-10
Authors: Reinhard J Sauter; Johannes Patzelt; Matthias Mezger; Henry Nording; Jan-Christian Reil; Mohammed Saad; Peter Seizer; Juergen Schreieck; Peter Rosenberger; Harald F Langer; Harry Magunia Journal: Int J Cardiol Heart Vasc Date: 2019-08-30