What is the clinical evidence from this study?

Study design: Cohort. Population: Severe aortic stenosis (n=4344). Intervention: Persistent right ventricular dysfunction vs. Improvement in right ventricular function. Primary outcome: All-cause mortality (HR 3.3, 95% CI 1.95-5.7, p=< .001).

March 7, 2021

Prognostic implication of right ventricular dysfunction and tricuspid regurgitation following transcatheter aortic valve replacement

Q: What are the key findings of this study?

Persistent right ventricular dysfunction following TAVR was associated with a significantly increased risk of long-term mortality (HR 3.3; 95% CI 1.95-5.7; p<0.001).

Q: What does this research mean for the field?

Persistent right ventricular dysfunction following transcatheter aortic valve replacement is associated with a significantly increased risk of long-term mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Persistent right ventricular dysfunction following TAVR was associated with a significantly increased risk of long-term mortality (HR 3.3; 95% CI 1.95-5.7; p<0.001).

Study Design

Type

Cohort (n=4,344)

Multicenter

Yes

Structured PICO

Does baseline ≥moderate tricuspid regurgitation or right ventricular dysfunction predict long-term mortality in severe aortic stenosis patients undergoing TAVR?

Population

4,344 consecutive patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) from the Israeli multicenter TAVR registry.

Intervention

Baseline ≥moderate tricuspid regurgitation (TR) and ≥moderate right ventricular (RV) dysfunction

Comparator

Absence of ≥moderate TR and RV dysfunction, or improvement in RV function post-TAVR

Outcome

All-cause mortalityhard clinical

While baseline moderate or greater TR and RV dysfunction do not independently predict long-term mortality after TAVR when adjusting for other echo parameters, persistent RV dysfunction post-TAVR is a strong predictor of mortality.

Main Result

Effect estimate: HR 3.3 (95% CI 1.95-5.7)

p-value: p=< .001

Abstract

OBJECTIVES: Right ventricular (RV) dysfunction and tricuspid regurgitation (TR) are associated with adverse outcomes in severe aortic stenosis (AS) patients. Our aim was to evaluate the association between ≥moderate TR and RV dysfunction on long-term mortality following transcatheter aortic valve replacement (TAVR). METHODS: A retrospective analysis of the Israeli multicenter TAVR registry among 4,344 consecutive patients, with all-cause mortality as the main outcome measure. RESULTS: Echocardiographic assessment of TR grade and RV dysfunction was available for 3,733 and 1,850 patients, of whom ≥moderate TR and RV dysfunction was noted for 478(13%) and 78(4%), respectively. The mean follow-up time was 2.9 ± 2.3 years. In univariate models, ≥Moderate TR and ≥moderate RV dysfunction were associated with increased long-term mortality (HR 1.45, 95% CI 1.24-1.69, p < .001 and HR 1.73, 95% CI 1.21-2.47, p = 0.003, respectively). These finding did not remained significant after adjusting to echocardiographic parameters. A subset of patients with no improvement in RV function had the highest long-term mortality risk (HR 3.3, 95% CI 1.95-5.7, p < .001). CONCLUSION: When adjusted to multiple echocardiographic characteristics baseline ≥Moderate TR and ≥moderate RV dysfunction were not associated with long-term mortality following TAVR. Persistent RV dysfunction following TAVR was associated with the highest risk for mortality.

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