Right ventricular dysfunction by computed tomography associates with outcomes in severe aortic stenosis patients undergoing transcatheter aortic valve replacement

Miho Fukui; Paul Sorajja; Go Hashimoto; Bernardo B C Lopes; Larissa I Stanberry; Santiago Garcia; Mario Gössl; Victor Cheng; Maurice Enriquez-Sarano; Vinayak N Bapat; John R Lesser; João L Cavalcante

doi:10.1016/j.jcct.2021.11.005

Right ventricular dysfunction by computed tomography associates with outcomes in severe aortic stenosis patients undergoing transcatheter aortic valve replacement

J Cardiovasc Comput Tomogr. 2022 Mar-Apr;16(2):158-165. doi: 10.1016/j.jcct.2021.11.005. Epub 2021 Nov 14.

Affiliations

¹ Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
² Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
³ Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
⁴ Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA. Electronic address: Joao.Cavalcante@allina.com.

PMID: 34794909
DOI: 10.1016/j.jcct.2021.11.005

Abstract

Background: Although cardiac computed tomography angiography (CCTA) assessment of right ventricular dysfunction (RVD) is feasible, the incremental prognostic value remains uncertain in patients undergoing transcatheter aortic valve replacement (TAVR) evaluation. This study sought to determine the incremental clinical utility of RVD identification by CCTA while accounting for clinical and echocardiographic parameters.

Methods: Patients who underwent multiphasic ECG-gated functional CCTA using dual-source system for routine TAVR planning were evaluated. Biphasic contrast protocol injection allowed for biventricular contrast enhancement. CCTA-based RVD was defined as right ventricular ejection fraction (RVEF) < 50%. The association of CCTA-RVD with all-cause mortality and the composite outcome of death or heart failure hospitalization after TAVR was evaluated and examined for its incremental utility beyond clinical risk assessment and echocardiographic parameters.

Results: A total of 502 patients were included (median [IQR] age, 82 [77 to 87] years; 56% men) with a median follow-up of 22 [16 to 32] months. Importantly, 126 (25%) patients were identified as having RVD by CCTA that was not identified by echocardiography. CCTA-defined RVD predicted death and the composite outcome in both univariate analyses (HR for mortality, 2.15; 95% CI, 1.44-3.22; p < 0.001; HR for composite outcome, 2.11; 95% CI, 1.48-3.01; p < 0.001) and in multivariate models that included clinical risk factors and echocardiographic findings (HR for mortality, 1.74; 95% CI, 1.11-2.74; p = 0.02; HR for composite outcome, 1.63; 95% CI, 1.09-2.44; p = 0.02).

Conclusions: Functional CCTA assessment pre-TAVR correctly identified 25% of patients with RVD that was not evident on 2D echocardiography. The presence of RVD on CCTA independently associates with clinical outcomes post-TAVR.

Keywords: Aortic stenosis (AS); Cardiac computed tomography angiography (CCTA); Mortality; Right ventricle ejection fraction; Right ventricle function; Transcatheter aortic valve replacement (TAVR).

MeSH terms

Aged, 80 and over
Aortic Valve / diagnostic imaging
Aortic Valve / surgery
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / surgery
Computed Tomography Angiography
Female
Humans
Male
Predictive Value of Tests
Retrospective Studies
Risk Factors
Severity of Illness Index
Stroke Volume
Transcatheter Aortic Valve Replacement*
Treatment Outcome
Ventricular Dysfunction, Right* / diagnostic imaging
Ventricular Dysfunction, Right* / etiology
Ventricular Function, Right