Prognostic Value of Right Ventricular Free Wall Longitudinal Strain in Transcatheter Aortic Valve Implantation Outcomes.

BACKGROUND: Previously proposed staging classification based on cardiac damage highlighted that right ventricular (RV) damage reflects the most advanced stage in patients with severe aortic stenosis. This study aimed to investigate the association between RV damage detected by RV free wall longitudinal strain (RVFWLS) and outcomes in patients with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI).

METHODS: A total of 768 patients with severe aortic stenosis who underwent TAVI and echocardiographic images for RV functional assessment were included from a retrospective multicenter TAVI registry. The primary outcome was a composite of all-cause death and hospitalization due to cardiovascular events.

RESULTS: During a median follow-up of 21 (12-30) months, 213 patients (28%) experienced the primary end points. In the multivariable Cox proportional hazards model, a higher absolute RVFWLS value was independently associated with better outcomes (adjusted hazard ratio [HR], 0.88 [95% CI, 0.84-0.91]). RVFWLS demonstrated incremental values superior to those of conventional RV parameters. Adding RVFWLS <17% as an RV damage (Stage 4) criterion in staging classification identified 272 (35%) patients in Stage 4. Patients with RVFWLS-incorporated Stage 4 had lower event-free survival than did those in the other stages (adjusted HR, 1.55 [95% CI, 1.35-1.77]).

CONCLUSION: In patients with severe aortic stenosis who underwent TAVI, RVFWLS was independently associated with outcomes and provided superior prognostic value than other conventional RV echocardiographic parameters. Incorporating RVFWLS in a staging classification for RV damage showed incremental value for predicting survival after TAVI over the original staging classification.