Right ventricular dysfunction (TAPSE <17 mm) was associated with increased all-cause mortality in patients with aortic stenosis (adjusted HR 1.55; 95% CI 1.21-1.97).
Cohort (n=2,181)
Does right ventricular systolic dysfunction (TAPSE <17 mm) increase the risk of all-cause death in patients with aortic stenosis?
Right ventricular dysfunction (TAPSE <17 mm) is an independent predictor of mortality in patients with aortic stenosis, regardless of whether they are managed conservatively or undergo early aortic valve replacement.
Effect estimate: HR 1.55 (95% CI 1.21-1.97)
p-value: p=<0.001
Background: Pulmonary hypertension is an established outcome predictor in patients with aortic stenosis (AS), but the prognostic impact of right ventricular dysfunction has not been well studied. Methods: We included 2181 patients (50.4% men; mean age, 77 years) with aortic valve area 24 mm (overall P <0.001). TAPSE <17 mm was associated with increased mortality after adjustment for established prognostic factors (adjusted hazard ratio HR, 1.55 95% CI, 1.21–1.97) and after further adjustment for aortic valve replacement (AVR; adjusted HR, 1.47 95% CI, 1.15–1.87). The excess mortality risk associated with TAPSE <17 mm was noticed in both patients managed initially conservatively (adjusted HR, 1.46 95% CI, 1.20–1.76) and patients who underwent early (within 3 months after diagnosis) AVR (adjusted HR, 1.61 95% CI, 1.03–2.52). In asymptomatic patients with severe AS and preserved ejection fraction, TAPSE <17 mm was independently predictive of mortality (adjusted HR, 2.14 95% CI, 1.31–3.51). Early AVR was associated with similar survival benefit in TAPSE <17 and ≥17 mm (adjusted HR, 0.23 95% CI, 0.16–0.34 for TAPSE <17 mm, adjusted HR, 0.26 95% CI, 0.19–0.35 for TAPSE ≥17 mm; P for interaction, 0.97). Conclusions: Right ventricular dysfunction is an important and independent predictor of mortality in AS. TAPSE <17 mm at the time of AS diagnosis is a marker of poor survival under conservative management and after AVR even in asymptomatic patients with severe AS. AVR was associated with a pronounced reduction in mortality independent of TAPSE suggesting that AVR should be discussed before right ventricular dysfunction occurs in severe AS.
Bohbot et al. (Wed,) conducted a cohort in Aortic stenosis (n=2,181). Right ventricular dysfunction (TAPSE <17 mm) vs. TAPSE ≥17 mm was evaluated on All-cause death (HR 1.55, 95% CI 1.21-1.97, p=<0.001). Right ventricular dysfunction (TAPSE <17 mm) was associated with increased all-cause mortality in patients with aortic stenosis (adjusted HR 1.55; 95% CI 1.21-1.97).