Amplitude of the V1-R Wave Predicts Survival After Transcatheter Aortic Valve Replacement

Background and Objectives: The function of the right heart and the pulmonary artery pressure have been linked to outcomes following transcatheter aortic valve replacement (TAVR). This study utilized the V1-R wave amplitude from pre-procedural electrocardiography as an indicator of pulmonary artery pressure, examining its connection to one-year mortality post-TAVR. Materials and Methods: This retrospective study, conducted at a single center, involved patients with severe symptomatic aortic valve stenosis who underwent TAVR between March 2014 and September 2023. The study analyzed patients' pre-procedural V1-R wave amplitude on electrocardiography and systolic pulmonary artery pressure measured by transthoracic echocardiography. Patients who died within one year were classified as non-survivors; others as survivors. Results: Of the 236 patients, 56 (23.7%) died within one year of follow-up. A cut-off value of 66.5 µV for V1-R wave amplitude was associated with 66.1% sensitivity and 66.7% specificity (AUC: 0.735; 95% CI: 0.660-0.811), and 55.5 mmHg for systolic pulmonary artery pressure (sPAP) was associated with 67.9% sensitivity and 68.3% specificity (AUC: 0.708; 95% CI: 0.624-0.793) in predicting one-year mortality. The independent predictors of increased mortality included a history of cerebrovascular disease, elevated sPAP, and a high R-wave amplitude in lead V1. In contrast, statin use emerged as an independent predictor of reduced mortality. Conclusions: The V1-R wave amplitude and sPAP measured before TAVR were independent predictors of mortality following TAVR, highlighting the significance of right heart function.