ISSN 2996-8215
International Journal of Cardiology | Vol. 10, No. 11, November 2019 | pp. 81–88
DOI: 10.46882/2019/IJC/000128
Original Research Article
Prognostic Value of Right Ventricular Longitudinal Strain in Patients Undergoing Transcatheter Aortic Valve Implantation
Jean-Pierre Dubois¹, Pierre Vigneron¹, Lucia Rossi²
¹Department of Interventional Cardiology, Hôpital Européen Georges-Pompidou, Paris, France
²Department of Cardiac Surgery, University of Milan, Milan, Italy
Abstract:
Right ventricular (RV) function is an essential modifier of outcomes in patients with severe aortic stenosis, but conventional indices like tricuspid annular plane systolic excursion (TAPSE) are limited by angle dependency. Right ventricular free-wall longitudinal strain (RV-FWS) provides a highly precise index of global RV myocardial performance. This prospective study evaluated the 2-year prognostic value of baseline RV-FWS in high-risk patients undergoing transcatheter aortic valve implantation (TAVI). We followed 180 consecutive high-risk patients who underwent successful TAVI. Transthoracic speckle-tracking echocardiography was performed within 48 hours before the procedure to quantify baseline absolute RV-FWS. The primary endpoint was a composite of all-cause mortality or heart failure rehospitalization at 24 months. Impaired baseline RV-FWS (defined as an absolute value less than 16.0%) was identified in 54 patients (30.0%). At 2 years, the primary composite endpoint occurred significantly more frequently in patients with impaired baseline RV-FWS than in those with preserved strain (44.4% vs. 21.4%, log-rank p = 0.004). This difference was driven by higher rates of heart failure rehospitalization (33.3% vs. 13.5%, p = 0.01). Multivariable Cox regression confirmed that an absolute baseline RV-FWS less than 16.0% was an independent predictor of the 2-year composite outcome (hazard ratio: 2.14, 95% CI: 1.28–3.58, p = 0.004), whereas TAPSE lost independent predictive value in the fully adjusted model. Right ventricular free-wall longitudinal strain is a powerful independent predictor of long-term mortality and heart failure rehospitalization following TAVI.
Keywords: Aortic stenosis, Transcatheter aortic valve implantation, Right ventricular function, Speckle-tracking echocardiography, Longitudinal strain, Prognosis
Received: August 04, 2019; Revised: September 15, 2019; Accepted: October 10, 2019; Published: November 18, 2019