Scheggi Valentina, Bohbot Yohann, Hasan Jasim, Vanhaecke Pierre, Fumagalli Carlo, Meucci Francesco, Garofalo Manuel, Mazzotta Ruggero, Salvi Samuele, Panichella Giorgia, Biagiotti Lucrezia, Orlandi Matteo, Fanizzi Angela Ilaria, Zoppetti Nicola, Valenti Renato, Cerillo Alfredo, Stefàno Pier Luigi, Di Mario Carlo, Rusinaru Dan, Mirode Anfani, Tribouilloy Christophe, Marchionni Niccolò
Division of Internal Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy.
Department of Cardiology, Amiens University Hospital, Amiens, France.
Intern Emerg Med. 2025 Jun 3. doi: 10.1007/s11739-025-03985-5.
Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis (AS), especially in high-risk surgical patients. However, the impact of right ventricular (RV) dysfunction on TAVI outcomes remains unclear. This study aimed to evaluate RV function, measured by tricuspid annular plane systolic excursion (TAPSE), as a predictor of mortality post-TAVI. In a multicenter retrospective cohort study, 637 patients with severe AS who underwent TAVI were assessed for RV function using TAPSE measurements. Data were analyzed to explore the relationship between TAPSE and mortality at 30 days and 1 year, adjusting for demographic factors, comorbidities, and echocardiographic parameters. The prognostic value of the RV-pulmonary artery coupling parameter (TAPSE/PASP) was also investigated. A reduced TAPSE was identified as an independent predictor of 30-day mortality, with each 1-mm increase in TAPSE linked to a 14% reduction in mortality risk (HR 0.86 [95% CI 0.76-0.99]; p = 0.033). The association between TAPSE and 1-year mortality was weaker, with long-term outcomes more strongly influenced by the Charlson Comorbidity Index (CCI) (HR 1.2 [95% CI 1.0-1.3]; p = 0.007). In addition, TAPSE/PASP showed no significant correlation with mortality outcomes. Reduced TAPSE is a valuable predictor of early mortality following TAVI, suggesting that preoperative TAPSE assessments may enhance risk stratification and early post-procedural management. In contrast, long-term mortality in TAVI patients appears to depend more on overall comorbidity burden. Future research should consider integrating TAPSE into risk models to improve individualized TAVI patient care.
经导管主动脉瓣植入术（TAVI）是重度主动脉瓣狭窄（AS）的标准治疗方法，尤其适用于手术风险高的患者。然而，右心室（RV）功能障碍对TAVI预后的影响仍不明确。本研究旨在评估通过三尖瓣环平面收缩期位移（TAPSE）测量的右心室功能，作为TAVI术后死亡率的预测指标。在一项多中心回顾性队列研究中，对637例行TAVI的重度AS患者使用TAPSE测量评估右心室功能。分析数据以探讨TAPSE与30天和1年死亡率之间的关系，并对人口统计学因素、合并症和超声心动图参数进行校正。还研究了右心室-肺动脉耦合参数（TAPSE/PASP）的预后价值。TAPSE降低被确定为30天死亡率的独立预测指标，TAPSE每增加1毫米，死亡风险降低14%（HR 0.86 [95% CI 0.76-0.99]；p = 0.033）。TAPSE与1年死亡率之间的关联较弱，长期预后受Charlson合并症指数（CCI）的影响更大（HR 1.2 [95% CI 1.0-1.3]；p = 0.007）。此外，TAPSE/PASP与死亡率结局无显著相关性。TAPSE降低是TAVI术后早期死亡率的有价值预测指标，提示术前TAPSE评估可能会改善风险分层和术后早期管理。相比之下，TAVI患者的长期死亡率似乎更多地取决于总体合并症负担。未来的研究应考虑将TAPSE纳入风险模型，以改善TAVI患者的个体化治疗。
