Why the study?
Mortality following TAVR remains high in patients with post-procedural left ventricular systolic dysfunction, but the clinical variables associated with worse clinical outcomes in this population were unclear.
Does the presence of moderate or greater tricuspid regurgitation following TAVR increase 2-year cardiovascular mortality in patients with post-TAVR LVEF < 50%?
Cohort (n=298)
Yes
Does the presence of moderate or greater tricuspid regurgitation following TAVR increase 2-year cardiovascular mortality in patients with post-TAVR LVEF < 50%?
Hazard Ratio: 3.41 (95% CI 1.15–10.1)
Absolute Event Rate: 30% vs 12%
p-value: p=0.001
In patients with post-TAVR left ventricular systolic dysfunction, the presence of moderate or greater tricuspid regurgitation is strongly associated with increased 2-year cardiovascular mortality.
BACKGROUND: Mortality following transcatheter aortic valve replacement (TAVR) in patients with post-procedural left ventricular systolic dysfunction remains high. We investigated clinical variables associating with worse clinical outcomes following TAVR in patients with systolic dysfunction. METHODS: We retrospectively investigated 2588 patients with severe aortic stenosis who received TAVR and were enrolled in the optimized transcatheter valvular intervention (OCEAN-TAVI) multicenter registry (UMIN000020423). The association between the clinical variables following TAVR and 2-year cardiovascular mortality was investigated among those with post-TAVR left ventricular ejection fraction less than 50%. RESULTS: A total of 298 patients (median 85 years old, 131 men) were included. The presence of moderate or greater tricuspid regurgitation following TAVR was independently associated with 2-year mortality (adjusted hazard ratio 3.41, 95% confidence interval 1.15-10.1), and significantly discriminated 2-year cardiovascular mortality (30% vs. 12%, p = 0.001). No patients with any improvement in tricuspid regurgitation had cardiovascular death. CONCLUSION: Following TAVR, the existence of significant tricuspid regurgitation was associated with cardiovascular mortality in patients with heart failure with reduced ejection fraction.
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Imamura et al. (2021) conducted a cohort in Severe aortic stenosis with post-TAVR left ventricular systolic dysfunction (n=298). Moderate or greater tricuspid regurgitation following TAVR vs. Less than moderate tricuspid regurgitation was evaluated on 2-year cardiovascular mortality (adjusted HR 3.41, 95% CI 1.15-10.1, p=0.001).
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