Subclinical Right Ventricular Dysfunction in Patients with Severe Aortic Stenosis: A Retrospective Case Series

Overview

Journal Cardiol Ther

Specialty Cardiology & Vascular Diseases

Date 2017 Jan 27

PMID 28124310

Citations 6

Authors

Dagmar F Hernandez-Suarez

Angel Lopez-Candales

Affiliations

Soon will be listed here.

Abstract

Introduction: There is scarce information about right ventricle (RV) function in patients with secondary pulmonary hypertension (PH) undergoing transcatheter aortic valve implantation (TAVI). We aim to identify possible RV abnormalities in patients referred for TAVI with severe aortic stenosis (sAS) and secondary PH.

Methods: Objective measures of RV function, as well as noninvasive estimates of pulmonary artery systolic pressures (PASP) were obtained from 30 sAS patients undergoing percutaneous valve intervention.

Results: Sixteen (53%) evaluated patients had some degree of PH. As expected, left ventricular mass index (281 ± 75 g/m) and left atrial volume index (89 ± 23 mL/m) values were significantly elevated. Even though RV end-systolic (8 ± 4 cm) and end-diastolic (17 ± 4 cm) areas were normal as well as RV fractional area change values (57 ± 16%); both longitudinal measures of RV systolic function such as tricuspid annular plane systolic excursion (1.9 ± 0.5 cm) and systolic velocity (10 ± 2 cm/s) were clearly reduced with just mild elevations in PASP (54 ± 7 mmHg).

Conclusions: Subclinical RV dysfunction is present in patients with sAS and secondary PH undergoing TAVI. Whether longitudinal measures of RV systolic function could predict clinical outcomes in these patients needs to be further explored.

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References

Barbash I, Escarcega R, Minha S, Ben-Dor I, Torguson R, Goldstein S . Prevalence and impact of pulmonary hypertension on patients with aortic stenosis who underwent transcatheter aortic valve replacement. Am J Cardiol. 2015; 115(10):1435-42. DOI: 10.1016/j.amjcard.2015.02.022. View

Pai R, Varadarajan P, Kapoor N, Bansal R . Aortic valve replacement improves survival in severe aortic stenosis associated with severe pulmonary hypertension. Ann Thorac Surg. 2007; 84(1):80-5. DOI: 10.1016/j.athoracsur.2007.02.094. View

Lopez-Candales A, Rajagopalan N, Gulyasy B, Edelman K, Bazaz R . Comparative echocardiographic analysis of mitral and tricuspid annular motion: differences explained with proposed anatomic-structural correlates. Echocardiography. 2007; 24(4):353-9. DOI: 10.1111/j.1540-8175.2006.00408.x. View

Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G . Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007; 28(2):230-68. DOI: 10.1093/eurheartj/ehl428. View

Lindman B, Maniar H, Jaber W, Lerakis S, Mack M, Suri R . Effect of tricuspid regurgitation and the right heart on survival after transcatheter aortic valve replacement: insights from the Placement of Aortic Transcatheter Valves II inoperable cohort. Circ Cardiovasc Interv. 2015; 8(4). PMC: 4438083. DOI: 10.1161/CIRCINTERVENTIONS.114.002073. View

Bazaz R, Edelman K, Gulyasy B, Lopez-Candales A . Evidence of robust coupling of atrioventricular mechanical function of the right side of the heart: insights from M-mode analysis of annular motion. Echocardiography. 2008; 25(6):557-61. DOI: 10.1111/j.1540-8175.2008.00676.x. View

Lucon A, Oger E, Bedossa M, Boulmier D, Verhoye J, Eltchaninoff H . Prognostic implications of pulmonary hypertension in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: study from the FRANCE 2 Registry. Circ Cardiovasc Interv. 2014; 7(2):240-7. DOI: 10.1161/CIRCINTERVENTIONS.113.000482. View

Silver K, Aurigemma G, Krendel S, Barry N, Ockene I, Alpert J . Pulmonary artery hypertension in severe aortic stenosis: incidence and mechanism. Am Heart J. 1993; 125(1):146-50. DOI: 10.1016/0002-8703(93)90067-j. View

Zlotnick D, Ouellette M, Malenka D, DeSimone J, Leavitt B, Helm R . Effect of preoperative pulmonary hypertension on outcomes in patients with severe aortic stenosis following surgical aortic valve replacement. Am J Cardiol. 2013; 112(10):1635-40. DOI: 10.1016/j.amjcard.2013.07.025. View

10.

Lopez-Candales A, Lopez F, Trivedi S, Elwing J . Right ventricular ejection efficiency: a new echocardiographic measure of mechanical performance in chronic pulmonary hypertension. Echocardiography. 2013; 31(4):516-23. DOI: 10.1111/echo.12419. View

11.

Gargiulo G, Sannino A, Capodanno D, Barbanti M, Buccheri S, Perrino C . Transcatheter Aortic Valve Implantation Versus Surgical Aortic Valve Replacement: A Systematic Review and Meta-analysis. Ann Intern Med. 2016; 165(5):334-44. DOI: 10.7326/M16-0060. View

12.

Iung B, Cachier A, Baron G, Messika-Zeitoun D, Delahaye F, Tornos P . Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?. Eur Heart J. 2005; 26(24):2714-20. DOI: 10.1093/eurheartj/ehi471. View

13.

Al Musa T, Uddin A, Fairbairn T, Dobson L, Steadman C, Kidambi A . Right ventricular function following surgical aortic valve replacement and transcatheter aortic valve implantation: A cardiovascular MR study. Int J Cardiol. 2016; 223:639-644. DOI: 10.1016/j.ijcard.2016.08.065. View