Impact of right ventricular size and function on survival following transcatheter aortic valve replacement

Ito, Saki; Pislaru, Sorin V.; Soo, Wern Miin; Huang, Runqing; Greason, Kevin L.; Mathew, Verghese; Sandhu, Gurpreet S.; Eleid, Mackram F.; Suri, Rakesh M.; Oh, Jae K.; Nkomo, Vuyisile T.

doi:10.1016/j.ijcard.2016.07.085

Cited by 49 publications

(32 citation statements)

References 29 publications

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“…As expressed in Figure , our search identified 12 eligible studies enrolling a total of 41,485 TAVI patients (including a study by McCarthy et al enrolling 34,576 patients from the transcatheter valve therapy [TVT] registry, not but including a study by Arnold et al enrolling 21,661 patients from the TVT registry) (Table ). The study by Arnold et al from the TVT registry reported an adjusted OR for 30‐day mortality and the study by McCarthy et al from the TVT registry provided an unadjusted OR for in‐hospital mortality, thus the former was extracted and combined in a meta‐analysis for early mortality (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…The study by Arnold et al from the TVT registry reported an adjusted OR for 30‐day mortality and the study by McCarthy et al from the TVT registry provided an unadjusted OR for in‐hospital mortality, thus the former was extracted and combined in a meta‐analysis for early mortality (Table ). We were able to extracted 12 HRs/ORs for midterm (6‐ to 30‐month) mortality from 10 studies. Of them, there were seven adjusted HRs for “≥moderate versus <moderate” TR, one unadjusted HR for “≥moderate versus <moderate” TR, two adjusted HRs for “≥moderate versus mild” TR, and two adjusted ORs for “severe versus <severe” TR.…”

Section: Resultsmentioning

confidence: 99%

“…The meta‐analysis for early mortality combining three ORs demonstrated a statistically significant 1.80‐fold increase in mortality with ≥moderate relative to <moderate TR (pooled OR, 1.80; 95% CI, 1.01–3.19; P for effect = 0.05; P for heterogeneity = 0.09; I 2 = 59%; Figure ). The primary meta‐analysis for midterm mortality combining all the 12 HRs/ORs indicated a statistically significant 1.96‐fold increase in mortality with significant relative to non‐significant TR (pooled HR/OR, 1.96; 95% CI, 1.35–2.85; P for effect = 0.0004; P for heterogeneity <0.00001; I 2 = 86%; Figure ). The secondary meta‐analysis for midterm mortality combining seven homogeneous HRs (adjusted HRs for “≥moderate versus <moderate” TR) showed a statistically significant 2.25‐fold increase in mortality with ≥moderate relative to <moderate TR (pooled HR, 2.25; 95% CI, 1.20 to 4.24; P for effect = 0.01; P for heterogeneity <0.00001; I 2 = 92%; Figure ).…”

Section: Resultsmentioning

confidence: 99%

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Impact of concurrent tricuspid regurgitation on mortality after transcatheter aortic‐valve implantation

Takagi

Hari

Kawai

et al. 2018

Cathet Cardio Intervent

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Objectives To determine whether concomitant tricuspid regurgitation (TR) is associated with increased mortality in patients with severe aortic stenosis (AS) undergoing transcatheter aortic‐valve implantation (TAVI), we performed a meta‐analysis of currently available studies. Methods MEDLINE and EMBASE were searched through May 2018. We included comparative or cohort studies enrolling patients with AS undergoing TAVI and reporting early (in‐hospital or 30‐day) and late (including early) all‐cause mortality in patients stratified by baseline TR grade. An odds ratio (OR) of early mortality and a hazard ratio (HR) of late mortality with its 95% CI for significant versus non‐significant (typically, ≥moderate versus

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Impact of concurrent tricuspid regurgitation on mortality after transcatheter aortic‐valve implantation

Takagi

Hari

Kawai

et al. 2018

Cathet Cardio Intervent

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“…In a recent study of 268 patients post-TAVR, measurements of RV dysfunction by way of RIMP were associated with worse survival following the procedure. 23 However, it is important to avoid RIMP if patients have varying R-R intervals and elevated RA pressures.…”

Section: Echocardiographymentioning

confidence: 99%

Multimodality Imaging of the Right Ventricle

Abouzeid

Shah

Johri

et al. 2017

Curr Treat Options Cardio Med

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Opinion Statement Right ventricular (RV) structure and function is clinically important in a wide range of conditions. While conventional echocardiography (echo) methods are widely used, its limitations in RV assessment due its complex geometry are well recognized. New applications of traditional echo methods as well as emerging echo techniques including 3-dimensional (3D) echo and speckle tracking strain have the potential to overcome limitations of conventional echo though widespread clinical use remains to be seen. Volumetric methods using cardiac magnetic resonance (CMR) and computed tomography (CT) provide accurate assessment of RV function without geometric assumptions. In addition, tissue characterization imaging for myocardial scar and fat using CMR and CT provides important information regarding the RV beyond structure and function alone and has clinical applications for diagnosis and prognosis in a broad range of pathologies. Limitations also exist for these two advanced modalities including availability and patient suitability for CMR and need for contrast and radiation exposure for CT. The complementary role of each modality for the RV as well as emerging evidence for the use of each imaging method in diagnosis and management of RV pathologies are outlined in this study.

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“…Involvement of the RV in inferior myocardial infarction increases the risk of cardiogenic shock and increases mortality, even when treated with primary percutaneous coronary intervention (PCI) 2. Pre‐existing RV failure portends a poor prognosis in several conditions,3 and perioperative RV dilatation and dysfunction are independent prognostic risk factors after transcatheter aortic valve replacement (TAVR) 4, 5. Acute deterioration in RV function often has important hemodynamic and clinical consequences.…”

Section: Introductionmentioning

confidence: 99%

Stunning and Right Ventricular Dysfunction Is Induced by Coronary Balloon Occlusion and Rapid Pacing in Humans: Insights From Right Ventricular Conductance Catheter Studies

Axell

Giblett

White

et al. 2017

JAHA

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BackgroundWe sought to determine whether right ventricular stunning could be detected after supply (during coronary balloon occlusion [BO]) and supply/demand ischemia (induced by rapid pacing [RP] during transcatheter aortic valve replacement) in humans.Methods and ResultsTen subjects with single‐vessel right coronary artery disease undergoing percutaneous coronary intervention with normal ventricular function were studied in the BO group. Ten subjects undergoing transfemoral transcatheter aortic valve replacement were studied in the RP group. In both, a conductance catheter was placed into the right ventricle, and pressure volume loops were recorded at baseline and for intervals over 15 minutes after a low‐pressure BO for 1 minute or a cumulative duration of RP for up to 1 minute. Ischemia‐induced diastolic dysfunction was seen 1 minute after RP (end‐diastolic pressure [mm Hg]: 8.1±4.2 versus 12.1±4.1, P<0.001) and BO (end‐diastolic pressure [mm Hg]: 8.1±4.0 versus 8.7±4.0, P=0.03). Impairment of systolic and diastolic function after BO remained at 15‐minutes recovery (ejection fraction [%]: 55.7±9.0 versus 47.8±6.3, P<0.01; end‐diastolic pressure [mm Hg]: 8.1±4.0 versus 9.2±3.9, P<0.01). Persistent diastolic dysfunction was also evident in the RP group at 15‐minutes recovery (end‐diastolic pressure [mm Hg]: 8.1±4.1 versus 9.9±4.4, P=0.03) and there was also sustained impairment of load‐independent indices of systolic function at 15 minutes after RP (end‐systolic elastance and ventriculo‐arterial coupling [mm Hg/mL]: 1.25±0.31 versus 0.85±0.43, P<0.01).ConclusionsRP and right coronary artery balloon occlusion both cause ischemic right ventricular dysfunction with stunning observed later during the procedure. This may have intraoperative implications in patients without right ventricular functional reserve.

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Impact of right ventricular size and function on survival following transcatheter aortic valve replacement

Cited by 49 publications

References 29 publications

Impact of concurrent tricuspid regurgitation on mortality after transcatheter aortic‐valve implantation

Impact of concurrent tricuspid regurgitation on mortality after transcatheter aortic‐valve implantation

Multimodality Imaging of the Right Ventricle

Stunning and Right Ventricular Dysfunction Is Induced by Coronary Balloon Occlusion and Rapid Pacing in Humans: Insights From Right Ventricular Conductance Catheter Studies

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