Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Kamml, C.
Right ventricular function as predictor of outcome after transcatheter aortic valve implantation (TAVI)
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2021. pp. 58
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Rainer Peter
- Schmid Johannes
- Altmetrics:
- Abstract:
- Introduction: Aortic Stenosis (AS) is the most prevalent primary valvular heart disease in Europe and North America and associated with considerable morbidity and mortality. The only treatment shown to improve survival in severe AS is valve replacement. In current clinical practice the decision between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement is made by an interdisciplinary team based on cardiac and extracardiac characteristics of the patient as well as several risk scores. Recent studies have shown that none of the established risk scores were able to achieve a satisfactory level of risk prediction in patients undergoing TAVI. There is growing evidence that right ventricular (RV) parameters predict mortality in patients undergoing TAVI. This study seeks to determine if RV parameters obtained via cardiac magnetic resonance imaging (CMR) can predict mortality in patients undergoing TAVI and might be of additional value in preprocedural risk evaluation. Methods: Patients with severe AS were prospectively recruited to undergo 1.5T-CMR before TAVI. After exclusion of 11 patients, CMR images of 112 patients were analysed using dedicated tissue tracking software (Circle cvi42). Obtained parameters included volumetric data, such as ejection fraction (EF) and end-diastolic volume index (EDVI), and global longitudinal and circumferential myocardial strain (GLS, GCS) of both the left ventricle (LV) and RV. These parameters were correlated with clinical data including invasively measured haemodynamic parameters and laboratory markers, and were associated with outcomes in uni- and multivariate cox regressions. Primary endpoint was 3-year cardiovascular mortality, secondary endpoints were two-year and one-year cardiovascular mortality. Results: Median follow-up was 3.9 years (2.3-2.7). Mortality after one and three years was 14.3% (16/112) and 28.6% (32/112), respectively. Mean CMR derived RV-EF was 54.6±12.8%, mean RV-GLS was -21.3±5.8%, mean RV-GCS was -13.5±3.6%, median RV-EDVI was 74.6ml (IQR 63.2 -92.2). RV-EF, RV-GLS and RV-EDVI were significant predictors of three-year cardiovascular mortality in univariate Cox regression, while LV-EF and LV-GCS did not predict cardiovascular mortality. In multivariate cox regression we found that RV-EF and RV-EDVI remained significant predictors for cardiovascular mortality after three years when adjusted for sex and age, whereas RV-GLS remained significant for sex. Conclusion: CMR derived RV functional parameters showed good predictive value for one-, two- and three-year cardiovascular mortality in our cohort. They performed better than LV functional parameters and may improve prediction of outcome after TAVI. Further studies are needed to evaluate a possible integration of RV parameters into existing risk scores.