The incidence and prognostic implications of worsening right ventricular function after surgical or transcatheter aortic valve replacement: insights from PARTNER IIA

Paul C. Cremer, Yiran Zhang, Maria Alu, L. Leonardo Rodriguez, Brian R. Lindman, Alan Zajarias, Rebecca T. Hahn, Stamatios Lerakis, S Chris Malaisrie, Pamela S. Douglas, Philippe Pibarot, Lars G. Svensson, Martin B. Leon, Wael A. Jaber

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Aims: In patients randomized to transcatheter or surgical aortic valve replacement (TAVR, SAVR), we sought to determine whether SAVR is associated with worsening right ventricular (RV) function and whether RV deterioration is associated with mortality. Methods and results: In 1376 patients from PARTNERIIA with paired baseline and 30-day core lab echocardiograms, worsening RV function was defined as decline by at least one grade from baseline to 30 days. Our primary outcome was all-cause mortality from 30 days to 2 years. Among 744 patients with TAVR, 62 (8.3%) had worsening RV function, compared with 156 of 632 patients with SAVR (24.7%) (P < 0.0001). In a multivariable model, SAVR [odds ratio (OR) 4.05, 95% confidence interval (CI) 2.55-6.44], a dilated RV (OR 2.38, 95% CI 1.37-4.14), and more than mild tricuspid regurgitation (TR) (OR 2.58, 95% CI 1.25-5.33) were associated with worsening RV function. There were 169 deaths, and patients with worsening RV function had higher all-cause mortality [hazard ratio (HR) 1.98, 95% CI 1.40-2.79]. This association remained robust after adjusting for clinical and echocardiographic variables. Among patients with worsening RV function, there was no mortality difference between TAVR and SAVR (HR 1.16, 95% CI 0.61-2.18). The development of moderate or severe RV dysfunction from baseline normal RV function conferred the worst prognosis (HR 2.87, 95% CI 1.40-5.89). Conclusion: After aortic valve replacement, worsening RV function is more common in patients with baseline RV dilation, more than mild TR, and in patients treated with SAVR. Worsening RV function and the magnitude of deterioration have important prognostic implications.

Original languageEnglish (US)
Pages (from-to)2659-2667
Number of pages9
JournalEuropean heart journal
Volume39
Issue number28
DOIs
StatePublished - Jul 21 2018

Fingerprint

Right Ventricular Function
Incidence
Confidence Intervals
Tricuspid Valve Insufficiency
Mortality
Odds Ratio
Aortic Valve
Right Ventricular Dysfunction
Transcatheter Aortic Valve Replacement
Surgical Instruments
Dilatation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cremer, Paul C. ; Zhang, Yiran ; Alu, Maria ; Rodriguez, L. Leonardo ; Lindman, Brian R. ; Zajarias, Alan ; Hahn, Rebecca T. ; Lerakis, Stamatios ; Malaisrie, S Chris ; Douglas, Pamela S. ; Pibarot, Philippe ; Svensson, Lars G. ; Leon, Martin B. ; Jaber, Wael A. / The incidence and prognostic implications of worsening right ventricular function after surgical or transcatheter aortic valve replacement : insights from PARTNER IIA. In: European heart journal. 2018 ; Vol. 39, No. 28. pp. 2659-2667.
@article{20629d7f6f6048f8972d307c6abad8b2,
title = "The incidence and prognostic implications of worsening right ventricular function after surgical or transcatheter aortic valve replacement: insights from PARTNER IIA",
abstract = "Aims: In patients randomized to transcatheter or surgical aortic valve replacement (TAVR, SAVR), we sought to determine whether SAVR is associated with worsening right ventricular (RV) function and whether RV deterioration is associated with mortality. Methods and results: In 1376 patients from PARTNERIIA with paired baseline and 30-day core lab echocardiograms, worsening RV function was defined as decline by at least one grade from baseline to 30 days. Our primary outcome was all-cause mortality from 30 days to 2 years. Among 744 patients with TAVR, 62 (8.3{\%}) had worsening RV function, compared with 156 of 632 patients with SAVR (24.7{\%}) (P < 0.0001). In a multivariable model, SAVR [odds ratio (OR) 4.05, 95{\%} confidence interval (CI) 2.55-6.44], a dilated RV (OR 2.38, 95{\%} CI 1.37-4.14), and more than mild tricuspid regurgitation (TR) (OR 2.58, 95{\%} CI 1.25-5.33) were associated with worsening RV function. There were 169 deaths, and patients with worsening RV function had higher all-cause mortality [hazard ratio (HR) 1.98, 95{\%} CI 1.40-2.79]. This association remained robust after adjusting for clinical and echocardiographic variables. Among patients with worsening RV function, there was no mortality difference between TAVR and SAVR (HR 1.16, 95{\%} CI 0.61-2.18). The development of moderate or severe RV dysfunction from baseline normal RV function conferred the worst prognosis (HR 2.87, 95{\%} CI 1.40-5.89). Conclusion: After aortic valve replacement, worsening RV function is more common in patients with baseline RV dilation, more than mild TR, and in patients treated with SAVR. Worsening RV function and the magnitude of deterioration have important prognostic implications.",
author = "Cremer, {Paul C.} and Yiran Zhang and Maria Alu and Rodriguez, {L. Leonardo} and Lindman, {Brian R.} and Alan Zajarias and Hahn, {Rebecca T.} and Stamatios Lerakis and Malaisrie, {S Chris} and Douglas, {Pamela S.} and Philippe Pibarot and Svensson, {Lars G.} and Leon, {Martin B.} and Jaber, {Wael A.}",
year = "2018",
month = "7",
day = "21",
doi = "10.1093/eurheartj/ehy251",
language = "English (US)",
volume = "39",
pages = "2659--2667",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "Oxford University Press",
number = "28",

}

Cremer, PC, Zhang, Y, Alu, M, Rodriguez, LL, Lindman, BR, Zajarias, A, Hahn, RT, Lerakis, S, Malaisrie, SC, Douglas, PS, Pibarot, P, Svensson, LG, Leon, MB & Jaber, WA 2018, 'The incidence and prognostic implications of worsening right ventricular function after surgical or transcatheter aortic valve replacement: insights from PARTNER IIA', European heart journal, vol. 39, no. 28, pp. 2659-2667. https://doi.org/10.1093/eurheartj/ehy251

The incidence and prognostic implications of worsening right ventricular function after surgical or transcatheter aortic valve replacement : insights from PARTNER IIA. / Cremer, Paul C.; Zhang, Yiran; Alu, Maria; Rodriguez, L. Leonardo; Lindman, Brian R.; Zajarias, Alan; Hahn, Rebecca T.; Lerakis, Stamatios; Malaisrie, S Chris; Douglas, Pamela S.; Pibarot, Philippe; Svensson, Lars G.; Leon, Martin B.; Jaber, Wael A.

In: European heart journal, Vol. 39, No. 28, 21.07.2018, p. 2659-2667.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The incidence and prognostic implications of worsening right ventricular function after surgical or transcatheter aortic valve replacement

T2 - insights from PARTNER IIA

AU - Cremer, Paul C.

AU - Zhang, Yiran

AU - Alu, Maria

AU - Rodriguez, L. Leonardo

AU - Lindman, Brian R.

AU - Zajarias, Alan

AU - Hahn, Rebecca T.

AU - Lerakis, Stamatios

AU - Malaisrie, S Chris

AU - Douglas, Pamela S.

AU - Pibarot, Philippe

AU - Svensson, Lars G.

AU - Leon, Martin B.

AU - Jaber, Wael A.

PY - 2018/7/21

Y1 - 2018/7/21

N2 - Aims: In patients randomized to transcatheter or surgical aortic valve replacement (TAVR, SAVR), we sought to determine whether SAVR is associated with worsening right ventricular (RV) function and whether RV deterioration is associated with mortality. Methods and results: In 1376 patients from PARTNERIIA with paired baseline and 30-day core lab echocardiograms, worsening RV function was defined as decline by at least one grade from baseline to 30 days. Our primary outcome was all-cause mortality from 30 days to 2 years. Among 744 patients with TAVR, 62 (8.3%) had worsening RV function, compared with 156 of 632 patients with SAVR (24.7%) (P < 0.0001). In a multivariable model, SAVR [odds ratio (OR) 4.05, 95% confidence interval (CI) 2.55-6.44], a dilated RV (OR 2.38, 95% CI 1.37-4.14), and more than mild tricuspid regurgitation (TR) (OR 2.58, 95% CI 1.25-5.33) were associated with worsening RV function. There were 169 deaths, and patients with worsening RV function had higher all-cause mortality [hazard ratio (HR) 1.98, 95% CI 1.40-2.79]. This association remained robust after adjusting for clinical and echocardiographic variables. Among patients with worsening RV function, there was no mortality difference between TAVR and SAVR (HR 1.16, 95% CI 0.61-2.18). The development of moderate or severe RV dysfunction from baseline normal RV function conferred the worst prognosis (HR 2.87, 95% CI 1.40-5.89). Conclusion: After aortic valve replacement, worsening RV function is more common in patients with baseline RV dilation, more than mild TR, and in patients treated with SAVR. Worsening RV function and the magnitude of deterioration have important prognostic implications.

AB - Aims: In patients randomized to transcatheter or surgical aortic valve replacement (TAVR, SAVR), we sought to determine whether SAVR is associated with worsening right ventricular (RV) function and whether RV deterioration is associated with mortality. Methods and results: In 1376 patients from PARTNERIIA with paired baseline and 30-day core lab echocardiograms, worsening RV function was defined as decline by at least one grade from baseline to 30 days. Our primary outcome was all-cause mortality from 30 days to 2 years. Among 744 patients with TAVR, 62 (8.3%) had worsening RV function, compared with 156 of 632 patients with SAVR (24.7%) (P < 0.0001). In a multivariable model, SAVR [odds ratio (OR) 4.05, 95% confidence interval (CI) 2.55-6.44], a dilated RV (OR 2.38, 95% CI 1.37-4.14), and more than mild tricuspid regurgitation (TR) (OR 2.58, 95% CI 1.25-5.33) were associated with worsening RV function. There were 169 deaths, and patients with worsening RV function had higher all-cause mortality [hazard ratio (HR) 1.98, 95% CI 1.40-2.79]. This association remained robust after adjusting for clinical and echocardiographic variables. Among patients with worsening RV function, there was no mortality difference between TAVR and SAVR (HR 1.16, 95% CI 0.61-2.18). The development of moderate or severe RV dysfunction from baseline normal RV function conferred the worst prognosis (HR 2.87, 95% CI 1.40-5.89). Conclusion: After aortic valve replacement, worsening RV function is more common in patients with baseline RV dilation, more than mild TR, and in patients treated with SAVR. Worsening RV function and the magnitude of deterioration have important prognostic implications.

UR - http://www.scopus.com/inward/record.url?scp=85055401597&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055401597&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehy251

DO - 10.1093/eurheartj/ehy251

M3 - Article

C2 - 29741615

AN - SCOPUS:85055401597

VL - 39

SP - 2659

EP - 2667

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 28

ER -