Right Ventricular Dysfunction in Patients With Severe Aortic Stenosis Before and After Transcatheter Aortic Valve Implantation.

PURPOSE: Right ventricular dysfunction (RVD) is a prognostic factor in patients with severe aortic stenosis (AS). Some patients have prolonged RVD after transcatheter aortic valve implantation (TAVI). We aimed to identify the prevalence of RVD before and after TAVI and factors associated with preexisting and prolonged RVD in patients with severe AS.

METHODS

This retrospective single-center study included 198 patients with severe AS (86.0 ± 4.8 years; 72.7% female). RVD was defined as two of the three parameters being worse than the reference value: fractional area change, right ventricular free wall strain, and tricuspid annular plane systolic excursion.

RESULTS

Sixty-eight patients (34.3%) were diagnosed with preexisting RVD. Factors associated with preexisting RVD were left ventricular (LV) ejection fraction, LV stroke volume index, and ratio of early diastolic velocity to early diastolic annular velocity (E/e') on the septal side in a multivariable analysis combining baseline clinical and echocardiographic parameters (all p < 0.05). One year after TAVI, 16 of 47 patients (34.0%) were classified as having prolonged RVD. Patients with prolonged RVD had lower LV stroke volume index, greater relative wall thickness, and lower aortic valve mean pressure gradient before TAVI than patients without prolonged RVD (all p < 0.05).

CONCLUSION

RVD in patients with severe AS is associated with lower LV ejection fraction, lower LV stroke volume index, and higher septal E/e' at baseline. Smaller LV stroke volume, lower aortic valve mean pressure gradient, and greater relative wall thickness might be predictors of prolonged RVD 1 year after TAVI.