Right ventricle to pulmonary artery coupling in patients undergoing transcatheter aortic valve implantation

ObjectivesTo evaluate the prognostic value of the ratio between tricuspid annular plane systolic excursion (TAPSE)-pulmonary artery systolic pressure (PASP) as a determinant of right ventricular to pulmonary artery (RV-PA) coupling in patients undergoing transcatheter aortic valve replacement (TAVI)...

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Published in:Heart (British Cardiac Society) Vol. 105; no. 2; pp. 117 - 121
Main Authors: Sultan, Ibrahim, Cardounel, Arturo, Abdelkarim, Islam, Kilic, Arman, Althouse, Andrew D, Sharbaugh, Michael S, Gupta, Aman, Xu, Jeff, Fukui, Miho, Simon, Marc A, Schindler, John T, Lee, Joon S, Gleason, Thomas G, Cavalcante, João L
Format: Journal Article
Language:English
Published: England BMJ Publishing Group LTD 01.01.2019
Subjects:
Aged
Aged, 80 and over
Aortic Valve - surgery
Aortic Valve Stenosis - complications
Aortic Valve Stenosis - physiopathology
Aortic Valve Stenosis - surgery
Cardiac Surgical Procedures - methods
Cardiology
Echocardiography, Doppler
Ejection fraction
Female
Follow-Up Studies
Heart
Heart Failure - etiology
Heart Failure - prevention & control
Heart Ventricles - physiopathology
Heart Ventricles - surgery
Humans
Male
Medical prognosis
Middle Aged
Mortality
Prognosis
Pulmonary arteries
Pulmonary Artery - surgery
Pulmonary hypertension
Respiration
Retrospective Studies
Social security
Society
Studies
Transcatheter Aortic Valve Replacement
Ultrasonic imaging
Veins & arteries
Ventricular Function, Left
Ventricular Function, Right
United States > US
transcatheter valve interventions
secondary pulmonary hypertension
aortic stenosis
ISSN:1355-6037, 1468-201X, 1468-201X
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Summary:ObjectivesTo evaluate the prognostic value of the ratio between tricuspid annular plane systolic excursion (TAPSE)-pulmonary artery systolic pressure (PASP) as a determinant of right ventricular to pulmonary artery (RV-PA) coupling in patients undergoing transcatheter aortic valve replacement (TAVI).BackgroundRV function and pulmonary hypertension (PH) are both prognostically important in patients receiving TAVI. RV-PA coupling has been shown to be prognostic important in patients with heart failure but not previously evaluated in TAVI patients.MethodsConsecutive patients with severe aortic stenosis who received TAVI from July 2011 through January 2016 and with comprehensive baseline echocardiogram were included. All individual echocardiographic images and Doppler data were independently reviewed and blinded to the clinical information and outcomes. Cox models quantified the effect of TAPSE/PASP quartiles on subsequent all-cause mortality while adjusting for confounders.ResultsA total of 457 patients were included with mean age of 82.8±7.2 years, left ventricular ejection fraction (LVEF) 54%±13%, PASP 44±17 mm Hg. TAPSE/PASP quartiles showed a dose-response relationship with survival. This remained significant (HR for lowest quartile vs highest quartile=2.21, 95% CI 1.07 to 4.57, p=0.03) after adjusting for age, atrial fibrillation, LVEF, stroke volume index, Society of Thoracic Surgeons Predicted Risk of Mortality.ConclusionBaseline TAPSE/PASP ratio is associated with all-cause mortality in TAVI patients as it evaluates RV systolic performance at a given degree of afterload. Incorporation of right-side unit into the risk stratification may improve optimal selection of patients for TAVI.
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Contributors All coauthors have contributed to the manuscript preparation, read, and approve it. João L Cavalcante is wholly responsible for the content. All the co-authors have signed off on this and agree with her inclusion.
ISSN:1355-6037
1468-201X
1468-201X
DOI:10.1136/heartjnl-2018-313385