Subclinical Right Ventricular Dysfunction in Patients with Severe Aortic Stenosis: A Retrospective Case Series

Abstract

Introduction: There is scarce information about right ventricle (RV) function in patients with secondary pulmonary hypertension (PH) undergoing transcatheter aortic valve implantation (TAVI). We aim to identify possible RV abnormalities in patients referred for TAVI with severe aortic stenosis (sAS) and secondary PH. Methods: Objective measures of RV function, as well as noninvasive estimates of pulmonary artery systolic pressures (PASP) were obtained from 30 sAS patients undergoing percutaneous valve intervention. Results: Sixteen (53%) evaluated patients had some degree of PH. As expected, left ventricular mass index (281 ± 75 g/m2) and left atrial volume index (89 ± 23 mL/m2) values were significantly elevated. Even though RV end-systolic (8 ± 4 cm2) and end-diastolic (17 ± 4 cm2) areas were normal as well as RV fractional area change values (57 ± 16%); both longitudinal measures of RV systolic function such as tricuspid annular plane systolic excursion (1.9 ± 0.5 cm) and systolic velocity (10 ± 2 cm/s) were clearly reduced with just mild elevations in PASP (54 ± 7 mmHg). Conclusions: Subclinical RV dysfunction is present in patients with sAS and secondary PH undergoing TAVI. Whether longitudinal measures of RV systolic function could predict clinical outcomes in these patients needs to be further explored.