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Open Access 15-05-2024 | Transcatheter Aortic Valve Implantation | Original Paper

Right ventricular to pulmonary artery coupling in patients with different types of aortic stenosis undergoing TAVI

Authors: Julius Steffen, Melanie Lux, Thomas J. Stocker, Nikolaus Kneidinger, Kornelia Löw, Philipp M. Doldi, Magda Haum, Julius Fischer, Lukas Stolz, Hans Theiss, Konstantinos Rizas, Daniel Braun, Martin Orban, Sven Peterß, Jörg Hausleiter, Steffen Massberg, Simon Deseive

Published in: Clinical Research in Cardiology

Abstract

Background

Right ventricular (RV) dysfunction in patients undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) has long been disregarded. We aimed to assess the predictive value of RV to pulmonary artery coupling (RV/PAc), defined as tricuspid annular plane systolic excursion to systolic pulmonary artery pressure, on mortality in different flow types of AS after TAVI.

Methods

All patients undergoing TAVI for AS at our centre between 2018 and 2020 were assessed; 862 patients were analysed. The cohort was dichotomized using a ROC analysis (cut-off 0.512 mm/mmHg), into 429 patients with preserved and 433 patients with reduced RV/PAc.

Results

Reduced RV/PAc was associated with male sex and a higher rate of comorbidities. Short-term VARC-3 endpoints and NYHA classes at follow-up were comparable. Reduced RV/PAc was associated with higher 2-year all-cause mortality (35.0% [30.3–39.3%] vs. 15.4% [11.9–18.7%], hazard ratio 2.5 [1.9–3.4], p < 0.001). Cardiovascular mortality was almost tripled. Results were consistent after statistical adjustment and in a multivariate model.

Sub-analyses of AS flow types revealed lower RV/PAc in classical and paradoxical low-flow low-gradient AS, with the majority having reduced RV/PAc (74% and 59%). RV/PAc retained its predictive value in these subgroups.

Conclusions

RV dysfunction defined by low RV/PAc is a strong mortality predictor after TAVI independent of flow group. It should be incorporated in future TAVI risk assessment.

Graphical abstract

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Title: Right ventricular to pulmonary artery coupling in patients with different types of aortic stenosis undergoing TAVI
Authors: Julius Steffen
Melanie Lux
Thomas J. Stocker
Nikolaus Kneidinger
Kornelia Löw
Philipp M. Doldi
Magda Haum
Julius Fischer
Lukas Stolz
Hans Theiss
Konstantinos Rizas
Daniel Braun
Martin Orban
Sven Peterß
Jörg Hausleiter
Steffen Massberg
Simon Deseive
Publication date: 15-05-2024
Publisher: Springer Berlin Heidelberg
Keyword: Transcatheter Aortic Valve Implantation
Published in: Clinical Research in Cardiology
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-024-02457-8

2024 ASCO Annual Meeting

Springer Medicine

Right ventricular to pulmonary artery coupling in patients with different types of aortic stenosis undergoing TAVI

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

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