Right ventricular function and outcome in patients undergoing transcatheter aortic valve replacement

Area of Science:

• Cardiology
• Medical Imaging
• Cardiac Surgery

Background:

• Right ventricular dysfunction (RVD) is a known predictor of outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).
• Echocardiography is commonly used to assess RVD, but its predictive value compared to cardiovascular magnetic resonance (CMR) has not been fully established.

Purpose of the Study:

• To compare the predictive value of echocardiography-based RVD parameters with CMR-derived RV ejection fraction (RVEF) for clinical outcomes in TAVR patients.
• To determine if echocardiographic RVD parameters independently predict outcomes after adjusting for clinical risk factors.

Main Methods:

• Prospective study of 204 TAVR patients undergoing both echocardiography and CMR.
• Echocardiographic assessment included RV fractional area change (FAC) and other parameters; CMR assessed RVEF.
• Patients were followed for a composite endpoint of heart failure hospitalization and death.

Main Results:

• All echocardiographic RV function parameters were associated with NT-proBNP levels.
• RV fractional area change (FAC) and RVEF on echocardiography were associated with prolonged in-hospital stay.
• Only RVEF on CMR independently predicted the composite endpoint (heart failure hospitalization and death) after adjustment for EuroSCORE-II.

Conclusions:

• Echocardiography-based RVD assessment indicates advanced disease but does not independently predict outcomes in TAVR patients.
• RVEF measured by CMR is a robust, independent predictor of adverse clinical outcomes, including heart failure hospitalization and death, in TAVR patients.