A new integrative approach combining right heart catheterization and echocardiography to stage aortic stenosis-related cardiac damage

Tommaso Viva; Adriana Postolache; Mai-Linh Nguyen Trung; Pauline Danthine; Hélène Petitjean; Vito Domenico Bruno; Christophe Martinez; Mathieu Lempereur; Marco Guazzi; Samy Aghezzaf; Augustin Coisne; Cécile Oury; Raluca Dulgheru; Patrizio Lancellotti

doi:10.3389/fcvm.2023.1184308

A new integrative approach combining right heart catheterization and echocardiography to stage aortic stenosis-related cardiac damage

Front Cardiovasc Med. 2023 Aug 2:10:1184308. doi: 10.3389/fcvm.2023.1184308. eCollection 2023.

Authors

Tommaso Viva^#^{1

2

3}, Adriana Postolache^#¹, Mai-Linh Nguyen Trung¹, Pauline Danthine¹, Hélène Petitjean¹, Vito Domenico Bruno³, Christophe Martinez¹, Mathieu Lempereur¹, Marco Guazzi^{4

5}, Samy Aghezzaf⁶, Augustin Coisne^{6

7}, Cécile Oury¹, Raluca Dulgheru¹, Patrizio Lancellotti^{1

8}

Affiliations

¹ GIGA Cardiovascular Sciences, CHU Sart Tilman, Cardiology Department, University of Liège Hospital, Liège, Belgium.
² Department of Biomedical Sciences for Health, University of Milano, Milan, Italy.
³ Department of Minimally Invasive Cardiac Surgery, IRCCS Galeazzi-Sant'Ambrogio Hospital, Milan, Italy.
⁴ School of Medicine, Department of Biological Sciences, University of Milano, Milan, Italy.
⁵ Cardiology Division, San Paolo Hospital, Milan, Italy.
⁶ CHU Lille, Institut Pasteur de Lille, University Lille, Inserm, Lille, France.
⁷ Cardiovascular Research Foundation, New York, NY, United States.
⁸ Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy.

^# Contributed equally.

Abstract

Introduction: Although staging of the extent of aortic stenosis (AS)-related cardiac damages is usually performed via echocardiography, this technique has considerable limitations in assessing pulmonary artery and right chamber pressures. The present hypothesis-generating study sought to explore the efficacy of a staging system of cardiac damage based on echocardiographic and invasive [right heart catheterization (RHC)] hemodynamic parameters in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods: We studied 90 symptomatic patients with severe AS in whom echocardiographic and invasive evaluation by RHC was obtained prior to TAVI. Cardiac damage stages were defined as follows: no cardiac damage (stage 0), left ventricular (LV) damage (stage 1), left atrial or mitral valve damage (stage 2), pulmonary vasculature or tricuspid valve damage (stage 3), and right ventricular (RV) dysfunction or low-flow state (stage 4). With the integrative approach using RHC, pulmonary hypertension (PH) was defined as an mPAP ≥25 mmHg and the low-flow state corresponded to a cardiac index of <1.8 L/min/m² and a right atrial pressure of >10 mmHg.

Results: During follow-up (median: 2.9 years), 43 patients (47.8%) died. The integrative cardiac damage staging was associated with a significant increase in all-cause and cardiovascular mortality per each increase of cardiac damage stage, whereas the outcome was similar according to the echocardiographic staging.

Conclusions: A staging system of cardiac lesion based on echocardiographic and invasive hemodynamic parameters in patients with severe AS undergoing TAVI predicts mortality. Patients with pre-existing PH, ≥ moderate tricuspid regurgitation and/or RV dysfunction, and a low-flow state had a markedly increased risk of death. Further larger studies are needed to validate our findings.

Keywords: TAVR; aortic stenosis; echocardiography; right heart catheterization; staging.