Omran Hazem, Polimeni Alberto, Brandt Verena, Rudolph Volker, Rudolph Tanja K, Bleiziffer Sabine, Friedrichs Kai P, Faber Lothar, Dimitriadis Zisis
Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany.
Division of Cardiology, Department of Surgical and Medical Sciences, Magna Græcia University of Catanzaro, 88100 Catanzaro, Italy.
J Clin Med. 2021 Dec 15;10(24):5877. doi: 10.3390/jcm10245877.
Right ventricular (RV) dysfunction has been linked to worse outcomes in patients undergoing TAVI. Assessment of RV function is challenging due to its complex morphology. RV longitudinal strain (LS) assessed by speckle-tracking echocardiography (STE) is a novel measure that may overcome most of the limitations of conventional echocardiographic parameters of RV function. The aim of current study was to assess the prognostic value of RV LS in patients undergoing TAVI and to assess echocardiographic predictors of long-term mortality.
A retrospective analysis of all consecutive patients who underwent TAVI at our hospital between 1 January 2015 and 1 June 2016. Indication for TAVI was approved by a local heart-team. Echocardiographic data at baseline and after TAVI were re-analyzed and RV LS was measured in all patients with adequate image quality. A total of 229 patients were included in our study (mean age 83.8 ± 5 years, 62% women, mean EuroSCORE II 5.7 ± 5%). All-cause mortality occurred in 17.3% over a mean follow-up of 929 ± 373 days. In multivariate analysis, only baseline average RV free-wall LS (HR 1.05, 95% CI (1.01 to 1.10), = 0.049) and more than mild tricuspid valve regurgitation (TR) after TAVI (HR 4.39, 95% CI (2.22 to 8.70), < 0.001) independently increased the risk of all-cause mortality at long- term follow-up (2.5 years), while conventional echocardiographic parameters of RV function did not predict mortality.
Pre-procedural RV LS and post-procedural tricuspid regurgitation significantly predicted long-term all-cause mortality in patients undergoing TAVI while conventional echocardiographic parameters of RV function failed in predicting long-term outcome. RV longitudinal strain by STE should be considered in the routine echocardiographic assessments of patients with severe AS.
右心室（RV）功能障碍与接受经导管主动脉瓣置入术（TAVI）的患者预后较差有关。由于右心室形态复杂，对其功能进行评估具有挑战性。通过斑点追踪超声心动图（STE）评估的右心室纵向应变（LS）是一种新的测量方法，可能克服右心室功能传统超声心动图参数的大多数局限性。本研究的目的是评估右心室LS在接受TAVI患者中的预后价值，并评估长期死亡率的超声心动图预测因素。
对2015年1月1日至2016年6月1日期间在我院接受TAVI的所有连续患者进行回顾性分析。TAVI的适应证由当地心脏团队批准。对基线和TAVI后的超声心动图数据进行重新分析，并对所有图像质量足够的患者测量右心室LS。我们的研究共纳入229例患者（平均年龄83.8±5岁，62%为女性，平均欧洲心脏手术风险评估系统II 5.7±5%）。在平均929±373天的随访中，全因死亡率为17.3%。在多变量分析中，只有基线平均右心室游离壁LS（HR 1.05，95%CI（1.01至1.10），P = 0.049）和TAVI后中重度以上三尖瓣反流（TR）（HR 4.39，95%CI（2.22至8.70），P < 0.001）在长期随访（2.5年）中独立增加全因死亡风险，而右心室功能的传统超声心动图参数不能预测死亡率。
术前右心室LS和术后三尖瓣反流显著预测接受TAVI患者的长期全因死亡率，而右心室功能的传统超声心动图参数无法预测长期预后。在严重主动脉瓣狭窄患者的常规超声心动图评估中应考虑通过STE测量右心室纵向应变。
