P351Predictors of early improvement of right ventricular function assessed by bidimensional speckle tracking echocardiography after transcatheter aortic valve implantation


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Abstract

Introduction and objectives: Our purpose was to evaluate the predictors of improvement in right systolic ventricular (RV) function in high-risk patients with severe aortic valvular stenosis after transcatheter aortic valve implantation (TAVI).Methods: From June 2009 to December 2010, we selected consecutive patients with severe aortic stenosis and high surgical risk who were treated with the CoreValve percutaneous aortic prosthesis and had a basal and discharge echocardiographic study with valid data for RV strain analysis by means of bidimensional speckle tracking echocardiography (2DSTE). RV systolic function was assessed by transthoracic echocardiography (TTE) with quantitative conventional parameters: tricuspid annular plane systolic excursion by M-mode (TAPSE) and tricuspid annular systolic velocity by pulsed tissue doppler imaging (TAs TDI) as well as emerging echocardiographic techniques as 2DSTE: longitudinal strain in basal RV free wall (RV strain) and TAPSE by 2DSTE (data obtained in the apical four-chambers view, with a specific software -iE33, Qlab -Philips-). Pulmonary artery systolic pressure (PASP) was also measured. TTE studies were performed before TAVI and at discharge. The improvement of RV function was defined as an increase in RV strain greater than the mean of paired differences between baseline and discharge TTE after TAVI. Univariate clinical and echocardiographic potencial predictors for the improvement of RV function were analyzed.Results: 36 patients were included (mean age 76±7 years, 18 male). All parameters of RV function increased significantly after TAVI (TAPSE 17.1±2.5 mm vs 17.5±2.3, p=0.01, TAs TDI 12.2±1.7 cm/seg vs 12.9±1.7, p<0.001, TAPSE by 2DSTE 15.7±4.6 mm vs 17.6±4.3, p<0.001, RV strain -29.±6 vs -34±5, mean of differences 4.5±4, p<0.001), and PASP decreased from 37±9 to 29±10 mmHg, p<0.001.The improvement in the RV function (increase in RV strain > 4.5) was related to a greater basal PSAP (41±12 vs 31±10 mmHg, p=0.017), a worse basal RV strain (-27±6 vs -34±3, p<0.001) and a functional class III-IV (74% vs 31%, p=0.012), but not to left ventricular ejection fraction, severity of stenosis or another parameters of RV function.Conclusions: In this study, the improvement of RV function after TAVI with the CoreValve prosthesis in high risk patients with severe aortic valvular stenosis was associated with a worse basal functional class, worse RV function and higher PASP in the baseline echocardiogram.

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