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Lindsay AC, Harron K, Jabbour RJ, Kanyal R, Snow TM, Sawhney P, Alpendurada F, Roughton M, Pennell DJ, Duncan A, Di Mario C, Davies SW, Mohiaddin RH, Moat NE. Prevalence and Prognostic Significance of Right Ventricular Systolic Dysfunction in Patients Undergoing Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.115.003486. [DOI: 10.1161/circinterventions.115.003486] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 06/09/2016] [Indexed: 01/19/2023]
Abstract
Background—
Cardiovascular magnetic resonance (CMR) can provide important structural information in patients undergoing transcatheter aortic valve implantation. Although CMR is considered the standard of reference for measuring ventricular volumes and mass, the relationship between CMR findings of right ventricular (RV) function and outcomes after transcatheter aortic valve implantation has not previously been reported.
Methods and Results—
A total of 190 patients underwent 1.5 Tesla CMR before transcatheter aortic valve implantation. Steady-state free precession sequences were used for aortic valve planimetry and to assess ventricular volumes and mass. Semiautomated image analysis was performed by 2 specialist reviewers blinded to patient treatment. Patient follow-up was obtained from the Office of National Statistics mortality database. The median age was 81.0 (interquartile range, 74.9–85.5) years; 50.0% were women. Impaired RV function (RV ejection fraction ≤50%) was present in 45 (23.7%) patients. Patients with RV dysfunction had poorer left ventricular ejection fractions (42% versus 69%), higher indexed left ventricular end-systolic volumes (96 versus 40 mL), and greater indexed left ventricular mass (101 versus 85 g/m
2
;
P
<0.01 for all) than those with normal RV function. Median follow-up was 850 days; 21 of 45 (46.7%) patients with RV dysfunction died, compared with 43 of 145 (29.7%) patients with normal RV function (
P
=0.035). After adjustment for significant baseline variables, both RV ejection fraction ≤50% (hazard ratio, 2.12;
P
=0.017) and indexed aortic valve area (hazard ratio, 4.16;
P
=0.025) were independently associated with survival.
Conclusions—
RV function, measured on preprocedural CMR, is an independent predictor of mortality after transcatheter aortic valve implantation. CMR assessment of RV function may be important in the risk stratification of patients undergoing transcatheter aortic valve implantation.
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Affiliation(s)
- Alistair C. Lindsay
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Katie Harron
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Richard J. Jabbour
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Ritesh Kanyal
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Thomas M. Snow
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Paramvir Sawhney
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Francisco Alpendurada
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Michael Roughton
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Dudley J. Pennell
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Alison Duncan
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Carlo Di Mario
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Simon W. Davies
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Raad H. Mohiaddin
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Neil E. Moat
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
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Glauber M, Moten SC, Quaini E, Solinas M, Folliguet TA, Meuris B, Miceli A, Oberwalder PJ, Rambaldini M, Teoh KHT, Bhatnagar G, Borger MA, Bouchard D, Bouchot O, Clark SC, Dapunt OE, Ferrarini M, Fischlein TJM, Laufer G, Mignosa C, Millner R, Noirhomme P, Pfeiffer S, Ruyra-Baliarda X, Shrestha ML, Suri RM, Troise G, Gersak B. International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mattia Glauber
- Istituto Clinico Sant’ Ambrogio, Clinical & Research Hospital IRCCS-Gruppo Ospedaliero San Donato, Milano, Italy
| | - Simon C. Moten
- Austin Health and Royal Melbourne Hospital, Melbourne, Australia
| | - Eugenio Quaini
- Istituto Clinico Sant’ Ambrogio, Clinical & Research Hospital IRCCS-Gruppo Ospedaliero San Donato, Milano, Italy
| | - Marco Solinas
- Ospedale del Cuore G. Pasquinucci, Fondazione Toscana G. Monasterio, Massa, Italy
| | | | | | - Antonio Miceli
- Istituto Clinico Sant’ Ambrogio, Clinical & Research Hospital IRCCS-Gruppo Ospedaliero San Donato, Milano, Italy
| | | | | | - Kevin H. T. Teoh
- Southlake Regional Health Centre, McMaster University, Hamilton, Canada
| | - Gopal Bhatnagar
- Trillium Cardiovascular Associates, Mississauga, Ontario, Canada
| | | | | | | | | | | | - Matteo Ferrarini
- Istituto Clinico Sant’ Ambrogio, Clinical & Research Hospital IRCCS-Gruppo Ospedaliero San Donato, Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | - Borut Gersak
- University Medical Center Ljubljana, Ljubljana, Slovenia
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