Valvular & structural heart diseaseCohort study
Right Ventricular Dysfunction and Impaired Right Ventricular–Pulmonary Arterial Coupling in Paradoxical Low-Flow, Low-Gradient Aortic Stenosis
- Retrospective cohort study
- single-centre
Authors' conclusion
Adverse RV remodelling, RVD and impaired RV-PA coupling provide an explanation for low-flow and reduced stroke volume index in a subset of patients with pLFLG AS, and are associated with excess mortality after TAVI.
Study context
- Population
- Patients with paradoxical low-flow, low-gradient AS undergoing transcatheter aortic valve implantation (TAVI), University of Cologne Heart Center, March 2013–June 2021of 2739 native AS patients
- Participants
- 114 patients
- Exposure
- Right ventricular dysfunction (RVD) vs normal right ventricular (RV) function before TAVI
- Outcome
- All-cause mortality after TAVI
Main finding
As reported in the abstract
RVD associated with significantly higher all-cause mortality vs normal RV function
p = 0.016
Reduced fractional area change (FAC) associated with higher all-cause mortality
p = 0.049
Reduced tricuspid annular plane systolic excursion (TAPSE) associated with higher all-cause mortality
p = 0.035
Impaired RV-PA coupling (TAPSE/sPAP ratio <0.31 mm/mmHg) associated with higher all-cause mortality
p = 0.009
Observational data: associations, not effects.
Further findings
Prevalence of RV impairment
- Impaired FAC
- 21.9%
- Impaired TAPSE
- 45.6%
- RVD
- 50.0%
Independent predictors of all-cause mortality
- FAC, sPAP, TAPSE/sPAP ratio, right atrial area, RV diameter and tricuspid regurgitation
- adjusted for sex, age, BMI, EuroSCORE II, previous MI and mitral regurgitation
Original publication
Summarised from the published abstract; every number is checked against it