Comprehensive Right-Sided Assessment for Transcatheter Aortic Valve Replacement Risk Stratification: Time for a Change

Cavalcante, João L.; Simon, Marc A.; Chan, Stephen Y.

doi:10.1016/j.echo.2016.11.006

Cited by 27 publications

(20 citation statements)

References 41 publications

(50 reference statements)

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“…Patients were categorized into five stages (independent, not additive) depending on the presence or absence of extravalvular (extra aortic valve) cardiac damage or dysfunction as detected by transthoracic echocardiography before AVR—Stage 0: No other cardiac damage detected; Stage 1: LV damage as defined by presence of LV hypertrophy (LV mass index >95 g/m 2 for women, >115 g/m 2 for men), 5 severe LV diastolic dysfunction ( E / e ′ > 14), 6 or LV systolic dysfunction (LV ejection fraction <50%); Stage 2: LA or mitral valve damage or dysfunction as defined by the presence of an enlarged left atrium (>34 mL/m 2 ), the presence of atrial fibrillation, or the presence of moderate or severe mitral regurgitation; Stage 3: Pulmonary artery vasculature or tricuspid valve damage or dysfunction as defined by the presence of systolic pulmonary hypertension (systolic pulmonary arterial pressure ≥60 mmHg) or the presence of moderate or severe tricuspid regurgitation 7 , 8 ; and Stage 4: RV damage as defined by the presence of moderate or severe RV dysfunction ( Figure 1 ). 5 , 6 , 9 , 10 Patients were hierarchically classified in a given stage (worst stage) if at least one of the proposed criteria was met within that stage. These criteria were chosen based on their broad acceptance, prior validation as markers of abnormal cardiac function, their simplicity of acquisition, and their potential for future clinical external generalizability.…”

Section: Methodsmentioning

confidence: 99%

Staging classification of aortic stenosis based on the extent of cardiac damage

Généreux

Pîbarot

Redfors

et al. 2017

European Heart Journal

441

272

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AimsIn patients with aortic stenosis (AS), risk stratification for aortic valve replacement (AVR) relies mainly on valve-related factors, symptoms and co-morbidities. We sought to evaluate the prognostic impact of a newly-defined staging classification characterizing the extent of extravalvular (extra-aortic valve) cardiac damage among patients with severe AS undergoing AVR.Methods and resultsPatients with severe AS from the PARTNER 2 trials were pooled and classified according to the presence or absence of cardiac damage as detected by echocardiography prior to AVR: no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4). One-year outcomes were compared using Kaplan–Meier techniques and multivariable Cox proportional hazards models were used to identify 1-year predictors of mortality. In 1661 patients with sufficient echocardiographic data to allow staging, 47 (2.8%) patients were classified as Stage 0, 212 (12.8%) as Stage 1, 844 (50.8%) as Stage 2, 413 (24.9%) as Stage 3, and 145 (8.7%) as Stage 4. One-year mortality was 4.4% in Stage 0, 9.2% in Stage 1, 14.4% in Stage 2, 21.3% in Stage 3, and 24.5% in Stage 4 (Ptrend < 0.0001). The extent of cardiac damage was independently associated with increased mortality after AVR (HR 1.46 per each increment in stage, 95% confidence interval 1.27–1.67, P < 0.0001).ConclusionThis newly described staging classification objectively characterizes the extent of cardiac damage associated with AS and has important prognostic implications for clinical outcomes after AVR.

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Section: Methodsmentioning

confidence: 99%

Staging classification of aortic stenosis based on the extent of cardiac damage

Généreux

Pîbarot

Redfors

et al. 2017

European Heart Journal

441

272

View full text Add to dashboard Cite

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“… 10 Furthermore, RV size and function are not routinely measured or reported with outcomes of TAVR. 11 Of all the possible access sites, transfemoral transcatheter aortic valve replacement (TF-TAVR) accounts for 96% of the TAVR cases. 12 A recent meta-analysis showed that TAPSE remained unchanged following the TF-TAVR, but reduced significantly after the transapical TAVR (TA-TAVR) at the time of hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of right ventricular function in patients with aortic stenosis after transfemoral aortic valve replacement or surgical aortic valve replacement

Cao

Singh

Wang

et al. 2020

Therapeutic Advances in Chronic Disease

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Background: Right ventricular function (RVF) is an independent predictor of prognosis for patients undergoing aortic valve replacement: transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). The effect of transfemoral aortic valve replacement (TF-TAVR) on RVF is uncertain. We aimed to perform a meta-analysis of the effect of TF-TAVR on RVF in patients with aortic stenosis (AS) and compare the effect of TF-TAVR with SAVR. Methods: We searched relevant studies from PubMed, Embase, Cochrane Library databases, and Web of Science. Furthermore, two reviewers (Wang AQ and Cao YS) extracted all relevant data, which were then double checked by another two reviewers (Zhang M and Qi GM). We used the forest plot to present results. Tricuspid annular plane systolic excursion (TAPSE) was the primary outcome. Results: This meta-analysis included 11 studies. There were 353 patients who underwent TF-TAVR, and 358 patients who were subjected to SAVR. There was no significant difference in TAPSE at 1 week and 6 months as well as right ventricular ejection fraction (RVEF) at <2 weeks and 6 months after TF-TAVR. For the SAVR group, TAPSE at 1 week and 3 months as well as fractional area change (FAC) at 3 months post procedure were significantly aggravated, while RVEF did not change significantly. Moreover, TAPSE post-TF-TAVR was significantly improved as compared with post-SAVR. The △TAPSE, the difference between TAPSE post-procedure and TAPSE prior to procedure, was also significantly better in the TF-TAVR group than in the SAVR group. Conclusion: RVF was maintained post TF-TAVR. For SAVR, discrepancy in the measured parameters exists, as reduced TAPSE indicates compromised longitudinal RVF, while insignificant changes in RVEF implicate maintained RVF post procedure. Collectively, our study suggests that the baseline RV dysfunction and the effect of TF-TAVR versus SAVR on longitudinal RVF may influence the selection of aortic valve intervention.

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“…In particular, recent interest has highlighted the role of the right heart unit and pulmonary vascular indices. 10 , 11 , 12 The presence and severity of TR, pulmonary hypertension, and RV size and function have all been reported to delineate hemodynamic staging of the disease process and improve risk stratification. 12 The presence of mild functional TR in our patient that persisted after TAVR is consistent with findings by Jeong et al.…”

Section: Discussionmentioning

confidence: 99%

“… 10 , 11 , 12 The presence and severity of TR, pulmonary hypertension, and RV size and function have all been reported to delineate hemodynamic staging of the disease process and improve risk stratification. 12 The presence of mild functional TR in our patient that persisted after TAVR is consistent with findings by Jeong et al. 11 that persistent mild TR after surgical aortic valve replacement is not necessarily associated with poor outcome, though the impact of persistent TR after TAVR is less clear.…”

Section: Discussionmentioning

confidence: 99%