Prevalence and Prognostic Significance of Right Ventricular Dysfunction in Patients With Severe Low-Flow, Low-Gradient Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement.

Autor: Bellino M; Department of Medicine, Surgery and Dentistry University of Salerno Baronissi Salerno Italy., Ferruzzi GJ; Department of Medicine, Surgery and Dentistry University of Salerno Baronissi Salerno Italy., Giordano A; Interventional Cardiology Unit Pineta Grande Hospital Castel Volturno Caserta Italy., Attisano T; Interventional Cardiology Unit University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno Italy., Maiellaro F; Department of Medicine, Surgery and Dentistry University of Salerno Baronissi Salerno Italy., Citro R; Division of Clinical Cardiology, Responsible Research Hospital; Department of Medicine and Health Science University of Molise Campobasso Italy., Baldi C; Interventional Cardiology Unit University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno Italy., Corcione N; Interventional Cardiology Unit Pineta Grande Hospital Castel Volturno Caserta Italy., Morello A; Interventional Cardiology Unit Pineta Grande Hospital Castel Volturno Caserta Italy., Granata G; Department of Medicine, Surgery and Dentistry University of Salerno Baronissi Salerno Italy., Turino S; Department of Medicine, Surgery and Dentistry University of Salerno Baronissi Salerno Italy., Di Maio M; Department of Medicine, Surgery and Dentistry University of Salerno Baronissi Salerno Italy.; Interventional Cardiology Unit University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno Italy., Silverio A; Department of Medicine, Surgery and Dentistry University of Salerno Baronissi Salerno Italy., Galasso G; Department of Medicine, Surgery and Dentistry University of Salerno Baronissi Salerno Italy.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Nov 05; Vol. 13 (21), pp. e036239. Date of Electronic Publication: 2024 Nov 04.
DOI: 10.1161/JAHA.124.036239
Abstrakt: Background: Whether the presence of right ventricular (RV) dysfunction may influence the clinical outcome of patients with low-flow, low-gradient aortic stenosis (LFLG-AS) undergoing transcatheter aortic valve replacement (TAVR) has not yet been established.
Methods and Results: This study included consecutive patients with LFLG-AS undergoing TAVR at 2 high-volume Italian centers. RV dysfunction before TAVR procedure was defined as tricuspid annular plane systolic excursion assessed by transthoracic echocardiography lower than <17 mm. The primary outcome was all-cause death at 1 year. The propensity score weighting technique was implemented to account for potential selection bias between patients with and without RV dysfunction. A prespecified subgroup analysis was conducted to evaluate the consistency of the results in patients with classical and paradoxical LFLG-AS forms. This study included 392 patients; of them, 97 (24.7%) patients showed RV dysfunction before TAVR. At propensity score-weighted adjusted Cox regression analysis, RV dysfunction, according to dichotomous definition, was associated with an increased risk for the primary outcome (adjusted hazard ratio [HR], 3.11 [95% CI, 1.58-6.13]), cardiovascular death (adjusted HR, 3.26 [95% CI, 1.58-6.72]), and major adverse cardiovascular and cerebrovascular events (adjusted HR, 3.39 [95% CI, 1.76-6.53]). Conversely, no difference was detected for the risk of stroke and of permanent pacemaker implantation. No significant interaction of the classical and paradoxical LFLG-AS subgroups was detected for all the outcomes of interest.
Conclusions: This study suggests that RV dysfunction echocardiographically assessed by tricuspid annular plane systolic excursion may improve the prognostic stratification of patients with LFLG-AS undergoing TAVR.
Databáze: MEDLINE
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