Clinical impact of the right ventricular impairment in patients following transcatheter aortic valve replacement

Figure 1. Definition of RV sphericity index. This echocardiographic image in apical four chamber view indicates measurement of RV sphericity index and tricuspid annular diameter. Initially, the tricuspid annulus diameter during the end-diastolic phase was measured (line A). Subsequently, a line was drawn connecting the RV apex to the midpoint of line A (line B). Finally, a perpendicular line was depicted connecting the RV free wall and septum, intersecting the midpoint of line B (line C). The RV sphericity index was calculated as the ratio between line C / line B. RV, right ventricular.

Figure 2. Forest plot of the multivariate Cox regression analysis for two-year MACCE. The multivariate Cox regression analysis demonstrated that lower TAPSE, higher RV sphericity index, hepatobiliary system impairment, CKD stages 3B–5, males, and clinical frailty scale of > 4 were associated with higher 2-year MACCE. CI, confidence interval; CKD, chronic kidney disease; HR, hazard ratio; MACCE, major adverse cardiac and cerebrovascular events; RV, right ventricular; TAPSE, tricuspid annular plane systolic excursion.

Figure 3. Clinical impact of TAPSE and RV sphericity index on 2-year MACCE. The patients were classified into group 1 (TAPSE of ≥ 19 mm and RV sphericity index of < 0.377), group 2 (TAPSE of < 19 mm and RV sphericity of < 0.377), group 3 (TAPSE of ≥ 19 mm and RV sphericity index of ≥ 0.377), and group 4 (TAPSE of < 19 mm and RV sphericity index of < 0.377). Kaplan–Meier survival curve demonstrated that the incidence of MACCE at 2 years differed among the above groups (p = 0.002). Patients with abnormal values of TAPSE and RV sphericity index (group 4) indicated the highest incidence of the outcomes. MACCE, major adverse cardiac and cerebrovascular events; RV, right ventricular; TAPSE, tricuspid annular plane systolic excursion.

Figure 4. A comparison of the LV and RV characteristics. (A) A value of TAPSE was higher in patients with LVEF of ≥ 40%. (B) A value of RV sphericity index was higher in patients with PH. LV, left ventricular; LVEF, left ventricular ejection fraction; PH, pulmonary hypertension; RV, right ventricular; TAPSE, tricuspid annular plane systolic excursion.

Figure 5. Bland Altman analysis for reproducibility of the RV sphericity index. The blue dashed line indicates the mean and the red dashed lines represent the 95% limits of agreement. (A) The Bland Altman plot depicts good intra-observer agreement. X: The second measurement by S.H. Y: The first measurement by S.H. (B) This figure demonstrates good inter-observer agreement. X: measurement by S.H. Y: measurement by H.M. RV, right ventricular.