Association of Right Ventricular Longitudinal Strain with Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement.

Aortic Valve Stenosis / diagnostic imaging Echocardiography Heart Ventricles / diagnostic imaging Humans Transcatheter Aortic Valve Replacement Ventricular Dysfunction, Right Ventricular Function, Right
Aortic stenosis Longitudinal strain Mortality Right ventricular systolic function Speckle-tracking echocardiography Transcatheter aortic valve replacement

Journal

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
ISSN: 1097-6795
Titre abrégé: J Am Soc Echocardiogr
Pays: United States
ID NLM: 8801388

Informations de publication

Date de publication:
04 2020
Historique:
received: 15 05 2019
revised: 25 11 2019
accepted: 25 11 2019
pubmed: 9 2 2020
medline: 25 9 2021
entrez: 9 2 2020
Statut: ppublish

Résumé

Conventional right ventricular (RV) echocardiographic measurements of systolic function (SF) have demonstrated conflicting results when their association with long-term outcomes after transcatheter aortic valve replacement (TAVR) is evaluated. RV free-wall (FW) longitudinal strain (LS) is a novel, single parameter to measure RV SF and may provide a better evaluation than fractional area change, tricuspid annular plane systolic excursion, and myocardial velocity (S'). The value of RV FW LS in patients undergoing TAVR and its association with 1-year mortality are unknown. The aim of this study was to test the hypothesis that RV FW LS would be associated with 1-year all-cause mortality in patients undergoing TAVR. Consecutive patients who underwent TAVR between 2007 and 2014 in whom RV FW LS was measurable were included; a subgroup that had 1-year follow-up echocardiographic evaluation of RV FW LS was analyzed. FW LS was derived from speckle-tracking analyses. The standard reference was determined as normal or impaired RV SF, the latter defined as the presence of ≥50% of tricuspid annular plane systolic excursion < 1.7 cm, S' < 9.5 cm/sec, and fractional area change < 35%. Cox proportional-hazards regression analysis was used to assess the association of RV FW LS with 1-year all-cause mortality. Of 612 patients, 334 were included for RV FW LS analysis on pre-TAVR echocardiography (feasibility 55%); exclusion criteria included atrial fibrillation (n = 92 [15%]), pacemaker (n = 73 [12%]), and poor image quality (n = 113 [18%]). Baseline impaired RV SF was present in 19% of cases. RV FW LS did not change significantly at 1-year follow-up, in both the groups with baseline impaired and normal function. Cox regression analysis showed that RV FW LS was associated with all-cause mortality at 1 year (hazard ratio, 1.06; 95% CI, 1.01-1.11). For each unit increase in RV FW LS, there was a 6% higher risk for 1-year mortality. In a high-risk TAVR population, RV FW LS should be considered a single echocardiographic parameter for the assessment of RV SF. When measurable, RV FW LS is associated with all-cause mortality at 1 year after TAVR.

Sections du résumé

BACKGROUND
Conventional right ventricular (RV) echocardiographic measurements of systolic function (SF) have demonstrated conflicting results when their association with long-term outcomes after transcatheter aortic valve replacement (TAVR) is evaluated. RV free-wall (FW) longitudinal strain (LS) is a novel, single parameter to measure RV SF and may provide a better evaluation than fractional area change, tricuspid annular plane systolic excursion, and myocardial velocity (S'). The value of RV FW LS in patients undergoing TAVR and its association with 1-year mortality are unknown. The aim of this study was to test the hypothesis that RV FW LS would be associated with 1-year all-cause mortality in patients undergoing TAVR.
METHODS
Consecutive patients who underwent TAVR between 2007 and 2014 in whom RV FW LS was measurable were included; a subgroup that had 1-year follow-up echocardiographic evaluation of RV FW LS was analyzed. FW LS was derived from speckle-tracking analyses. The standard reference was determined as normal or impaired RV SF, the latter defined as the presence of ≥50% of tricuspid annular plane systolic excursion < 1.7 cm, S' < 9.5 cm/sec, and fractional area change < 35%. Cox proportional-hazards regression analysis was used to assess the association of RV FW LS with 1-year all-cause mortality.
RESULTS
Of 612 patients, 334 were included for RV FW LS analysis on pre-TAVR echocardiography (feasibility 55%); exclusion criteria included atrial fibrillation (n = 92 [15%]), pacemaker (n = 73 [12%]), and poor image quality (n = 113 [18%]). Baseline impaired RV SF was present in 19% of cases. RV FW LS did not change significantly at 1-year follow-up, in both the groups with baseline impaired and normal function. Cox regression analysis showed that RV FW LS was associated with all-cause mortality at 1 year (hazard ratio, 1.06; 95% CI, 1.01-1.11). For each unit increase in RV FW LS, there was a 6% higher risk for 1-year mortality.
CONCLUSIONS
In a high-risk TAVR population, RV FW LS should be considered a single echocardiographic parameter for the assessment of RV SF. When measurable, RV FW LS is associated with all-cause mortality at 1 year after TAVR.

Identifiants

DOI: 10.1016/j.echo.2019.11.014 PMID: 32033789
pubmed: 32033789
pii: S0894-7317(19)31177-0
doi: 10.1016/j.echo.2019.11.014
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

452-460

Informations de copyright

Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Auteurs

Diego Medvedofsky (D)

Cardiovascular Core Laboratories, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, District of Columbia; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.

Edward Koifman (E)

Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.

Harish Jarrett (H)

Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.

Tatsuya Miyoshi (T)

Cardiovascular Core Laboratories, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, District of Columbia.

Toby Rogers (T)

Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.

Itsik Ben-Dor (I)

Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.

Lowell F Satler (LF)

Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.

Rebecca Torguson (R)

Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.

Ron Waksman (R)

Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.

Federico M Asch (FM)

Cardiovascular Core Laboratories, MedStar Health Research Institute at MedStar Washington Hospital Center, Washington, District of Columbia; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia. Electronic address: federico.asch@medstar.net.

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Classifications MeSH

questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Obstacle à l'éjection ventriculaire › Sténose aortique › Association of Right Ventricular Longitudinal...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic cardiovasculaire › Tests de la fonction cardiaque › Échocardiographie › Association of Right Ventricular Longitudinal...
questionsmedicales.fr › Système cardiovasculaire › Coeur › Ventricules cardiaques › Association of Right Ventricular Longitudinal...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Association of Right Ventricular Longitudinal...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Procédures de chirurgie cardiaque › Implantation de valve prothétique cardiaque › Remplacement valvulaire aortique par cathéter › Association of Right Ventricular Longitudinal...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Dysfonction ventriculaire › Dysfonction ventriculaire droite › Association of Right Ventricular Longitudinal...
questionsmedicales.fr › Phénomènes physiologiques respiratoires et circulatoires › Phénomènes physiologiques cardiovasculaires › Fonction ventriculaire › Fonction ventriculaire droite › Association of Right Ventricular Longitudinal...