Why the study?
Does baseline right ventricular dyssynchrony (RVSD4 >18 ms) predict 3-year all-cause mortality in patients with severe aortic stenosis undergoing TAVR?
Cohort (n=1,052)
No
Does baseline right ventricular dyssynchrony (RVSD4 >18 ms) predict 3-year all-cause mortality in patients with severe aortic stenosis undergoing TAVR?
Hazard Ratio: 4.008 (95% CI 2.541–6.323)
Absolute Event Rate: 34.8% vs 9.7%
p-value: p=<0.001
Right ventricular dyssynchrony measured by speckle-tracking echocardiography (RVSD4 >18 ms) is a strong, independent predictor of 3-year all-cause mortality in patients undergoing TAVR for severe aortic stenosis.
Background: (TAVR) are associated with cardiac damage, especially in those with pulmonary hypertension (PH) and right ventricular (RV) dysfunction. RV dyssynchrony is a novel prognostic indicator in PH patients, but its prognostic value in TAVR patients is unclear. We aimed to assess the prognostic value of RV dyssynchrony in TAVR patients. Methods: A total of 1,052 consecutive patients with severe aortic stenosis (AS) undergoing TAVR between April 2012 and December 2021 were studied. The primary endpoint was 3-year mortality. RVSD4 was defined as the standard deviation of the times to peak-systolic strain for the four mid-basal RV segments by two-dimensional (2D) speckle-tracking echocardiography (STE), and RV dyssynchrony was defined as RVSD4 >18 ms. Results: After 3-year follow-up, 182 patients (17.3%) died. Compared with the survivors, the non-survivors were older, included less females, had more comorbidities, comprised more patients with a pacemaker and New York Heart Association (NYHA) functional class III/IV, had a higher Society of Thoracic Surgeons (STS) score, worse laboratory data, and worse cardiac function. Cox regression analysis showed NYHA functional class III/IV [hazard ratio (HR): 2.134, 95% confidence interval (CI): 1.193-3.816, P=0.011], estimated glomerular filtration rate (eGFR; HR: 0.990, 95% CI: 0.980-1.000, P=0.044), and RVSD4 (HR: 1.028, 95% CI: 1.024-1.032, P<0.001) were independent risk factors for the mortality of patients after TAVR, and the fully adjusted multivariable HR of RV dyssynchrony was 4.008 (95% CI: 2.541-6.323). Additionally, a graded association between RV dyssynchrony and mortality at 3 years (P<0.001) was robustly revealed by Kaplan-Meier analyses. Conclusions: RV dyssynchrony is an independent and robust risk factor for 3-year mortality in patients with severe AS undergoing TAVR, and RVSD4 can be utilized as a risk stratification tool to prognosticate the long-term mortality of those patients.
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Yang et al. (2026) conducted a cohort in Severe aortic stenosis undergoing TAVR (n=1,052). Right ventricular dyssynchrony (RVSD4 >18 ms) vs. No right ventricular dyssynchrony (RVSD4 ≤18 ms) was evaluated on 3-year all-cause mortality (HR 4.008, 95% CI 2.541-6.323, p=<0.001).
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