Parameters of right ventricular function from cardiac magnetic resonance imaging predict mortality in a cohort of patients undergoing transcatheter aortic valve implantation (TAVI)
21 April 2020 (online)
Zielsetzung Recent studies showed that right ventricular (RV) function is closely associated with outcome in different cardiac conditions. This study aims to evaluate the prognostic value of RV functional parameters obtained from cardiac magnetic resonance imaging (cMR) for predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI).
Material und Methoden Patients with severe aortic stenosis were prospectively recruited to undergo 1.5T-cMR before TAVI. After exclusion of 11 patients due to insufficient image quality, cMR images of 112 patients (mean age 82±6 years; 34% women) were analysed using dedicated tissue tracking software (Circle cvi42). Obtained parameters included RV ejection fraction (RV-EF), RV global longitudinal and circumferential strain (RV-GLS, RV-GCS), RV longitudinal systolic velocity (RV-vel), left ventricular ejection fraction (LV-EF) and left ventricular global circumferential strain (LV-GCS).
Ergebnisse Mean follow-up was 3.5±1.8 years. Mortality after one and three years was 14% (16/112) and 29% (32/112), respectively. RV-EF, RV-GLS and RV-vel significantly predicted 3-year-all-cause-mortality in univariate Cox-regression (p=0.012, p=0.033, p=0.007), while RV-GCS, LV-EF and LV-GCS did not (p=0.25, p=0.32, p=0.33). Results remained significant for RV-EF and RV-vel when adjusted for sex and age (p=0.015, p=0.013). In ROC-analysis RV-EF, RV-GLS and RV-vel (AUC=0.64; 0.62; 0.63) outperformed current clinical risk scores (EuroSCORE-II, AV-Score, STS-Score) in predicting 3-year-all-cause-mortality.
Schlußfolgerungen cMR derived RV functional parameters, especially parameters of longitudinal contraction, predicted mortality in our cohort. They performed better than left ventricular functional parameters and currently used clinical risk scores and may improve outcome-prediction after TAVI.