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Right ventricle systolic function and right ventricle-pulmonary artery coupling in patients with severe aortic stenosis and the early impact of TAVI

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Abstract

Few data are available on the prevalence of right ventricle (RV) systolic dysfunction, assessed including RV strain, and RV to pulmonary artery (PA) coupling in patients with aortic stenosis (AS) submitted to TAVI and the early effect of the procedure. We performed standard and speckle tracking echocardiography in 80 patients with severe AS the day before TAVI and within 48 h after TAVI. In all patients we measured TAPSE/PASP (cut-off for RV-PA uncoupling 0.31) and in 60/80 we were able to analyze RV global longitudinal strain (RV-GLS) and RV free wall strain (RV-FWS). RVFAC and TAPSE were impaired in 8.3% while RV-GLS and RV-FWS in 45% and 33.3% respectively before TAVI. TAPSE/PASP < 0.31 was documented in 7/80 patients (8.7%) before TAVI. These subjects differed from patients with TAPSE/PASP ≥ 0.31 for: enlarged left ventricular (LV) end-diastolic and end-systolic volumes (p < 0.001), worst LV ejection fraction (p < 0.001) and RVFAC (p < 0.001), worst RV-GLS and RV-FWS (p = 0.01 and p = 0.03) and bigger right atrium (RA) area (p < 0.001). After TAVI, RV systolic function did not improve while PASP significantly decreased (p = 0.005) driving the improvement of TAPSE/PASP (p = 0.01). Patients with TAPSE/PASP improvement (51%) differed from the others for worst pre-TAVI diastolic function (E/eʹ p = 0.045), RVFAC (p = 0.042), RV-GLS (p = 0.049) and RA area (p = 0.02). RV-GLS unveils RV systolic dysfunction in as much as 45% of patients with AS vs only 8.3% revealed by conventional echocardiography. RV systolic function does not significantly improve early after TAVI while RV-PA coupling does. Patients with lower TAPSE/PASP at baseline have worst LV and RV systolic function as well as larger RA. Patients who improve TAPSE/PASP after TAVI are those with worst diastolic function, RV systolic function and larger RA at baseline.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Rosa Lillo

  2. Catholic University of the Sacred Heart, Rome, Italy

    Rosa Lillo, Gessica Ingrasciotta, Bianca Przbybylek, Giulia Iannaccone, Carlo Trani, Gaetano Antonio Lanza, Antonella Lombardo, Francesco Burzotta & Massimo Massetti

  3. Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy

    Francesca Graziani, Gabriella Locorotondo, Daniela Pedicino, Cristina Aurigemma, Enrico Romagnoli, Carlo Trani, Gaetano Antonio Lanza, Antonella Lombardo, Francesco Burzotta & Massimo Massetti

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by FG and RL. The first draft of the manuscript was written by RL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Francesca Graziani.

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Conflict of interest

Francesco Burzotta, Carlo Trani, Enrico Romagnoli and Cristina Aurigemma received speaker’s fees from Abbott, Medtronic and Abiomed. Other authors have no conflicts of interest.

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Lillo, R., Graziani, F., Ingrasciotta, G. et al. Right ventricle systolic function and right ventricle-pulmonary artery coupling in patients with severe aortic stenosis and the early impact of TAVI. Int J Cardiovasc Imaging 38, 1761–1770 (2022). https://doi.org/10.1007/s10554-022-02569-0

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