Granot Yoav, Merdler Ilan, Finkelstein Ariel, Arbel Yaron, Banai Shmuel, Topilsky Yan, Scwartz Lorin Arie, Segev Amit, Barbash Israel, Fefer Paul, Danenberg Haim, Shuvy Mony, Perlman Gidon, Kornowski Ran, Shapira Yaron, Orvin Katia, Steinvil Arie
Department of Cardiology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Leviev Heart Center, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Catheter Cardiovasc Interv. 2021 Nov 1;98(5):E758-E767. doi: 10.1002/ccd.29639. Epub 2021 Mar 7.
Right ventricular (RV) dysfunction and tricuspid regurgitation (TR) are associated with adverse outcomes in severe aortic stenosis (AS) patients. Our aim was to evaluate the association between ≥moderate TR and RV dysfunction on long-term mortality following transcatheter aortic valve replacement (TAVR).
A retrospective analysis of the Israeli multicenter TAVR registry among 4,344 consecutive patients, with all-cause mortality as the main outcome measure.
Echocardiographic assessment of TR grade and RV dysfunction was available for 3,733 and 1,850 patients, of whom ≥moderate TR and RV dysfunction was noted for 478(13%) and 78(4%), respectively. The mean follow-up time was 2.9 ± 2.3 years. In univariate models, ≥Moderate TR and ≥moderate RV dysfunction were associated with increased long-term mortality (HR 1.45, 95% CI 1.24-1.69, p < .001 and HR 1.73, 95% CI 1.21-2.47, p = 0.003, respectively). These finding did not remained significant after adjusting to echocardiographic parameters. A subset of patients with no improvement in RV function had the highest long-term mortality risk (HR 3.3, 95% CI 1.95-5.7, p < .001).
When adjusted to multiple echocardiographic characteristics baseline ≥Moderate TR and ≥moderate RV dysfunction were not associated with long-term mortality following TAVR. Persistent RV dysfunction following TAVR was associated with the highest risk for mortality.
右心室（RV）功能障碍和三尖瓣反流（TR）与严重主动脉瓣狭窄（AS）患者的不良预后相关。我们的目的是评估经导管主动脉瓣置换术（TAVR）后≥中度TR与RV功能障碍对长期死亡率的影响。
对以色列多中心TAVR登记处的4344例连续患者进行回顾性分析，以全因死亡率作为主要结局指标。
对3733例患者进行了TR分级和RV功能障碍的超声心动图评估，其中478例（13%）存在≥中度TR，78例（4%）存在RV功能障碍。平均随访时间为2.9±2.3年。在单变量模型中，≥中度TR和≥中度RV功能障碍与长期死亡率增加相关（HR分别为1.45，95%CI 1.24-1.69，p<0.001和HR 1.73，95%CI 1.21-2.47，p=0.003）。在调整超声心动图参数后，这些发现不再具有统计学意义。RV功能无改善的患者亚组长期死亡风险最高（HR 3.3，95%CI 1.95-5.7，p<0.001）。
在调整多个超声心动图特征后，基线≥中度TR和≥中度RV功能障碍与TAVR后的长期死亡率无关。TAVR后持续性RV功能障碍与最高死亡风险相关。
