title: Prevalence and prognostic value of right ventricular dysfunction in severe aortic stenosis.
abstract: OBJECTIVE
  Systolic pulmonary artery pressure (sPAP) is a well-known outcome predictor in patients with valvular heart disease. Limited data are available regarding the evaluation of right ventricular (RV) performance, particularly in patients with aortic stenosis (AS). The aim of this study was to evaluate the prevalence, determinants, and prognostic significance of RV dysfunction in severe AS independently from the strategy of treatment chosen.
  
  
  RESULTS
  Two hundred patients (mean age: 79.9 ± 8.8 years) with severe AS underwent two-dimensional and speckle tracking echocardiography for the evaluation of left ventricular (LV) and RV functions, aortic valve gradients, and sPAP. A tricuspid annular plane systolic excursion (TAPSE) ≤17 mm defined RV dysfunction. RV dysfunction was detected in 48 patients (24%). At multivariable regression analysis, LV global longitudinal strain (r = -0.29, P = 0.001), mean aortic gradient (r = 0.25, P = 0.002), and LV ejection fraction (r = 0.18, P = 0.02) were well correlated with TAPSE. After a median 16-month follow-up, cardiovascular death occurred in 17 patients. At multivariate Cox regression analysis, biventricular dysfunction (TAPSE ≤17 mm and LVEF ≤50%) emerged as the strongest predictor of prognosis (hazard ratio 4.08, 95% confidence interval 1.36-12.22; P = 0.012).
  
  
  CONCLUSIONS
  RV dysfunction is common in AS patients, and this finding can likely be accounted for by the RV-LV interdependence. Given that biventricular function impairment was a strong predictor of mortality in our population, we suggest that RV dysfunction should be systematically looked for in AS patients.
authors.affiliation: INSERM, UMR 1099, 35000 Rennes, France LTSI, Université de Rennes 1, 35000 Rennes, France Service de Cardiologie, CIC-IT 804, LISI INSERM U642, CHU Pontchaillou, 35000 Rennes, France.
authors.forename: Elena
authors.initials: E
authors.lastname: Galli
authors.affiliation: Service de Cardiologie, CIC-IT 804, LISI INSERM U642, CHU Pontchaillou, 35000 Rennes, France.
authors.forename: Yvan
authors.initials: Y
authors.lastname: Guirette
authors.affiliation: Service de Cardiologie, CIC-IT 804, LISI INSERM U642, CHU Pontchaillou, 35000 Rennes, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Feneon
authors.affiliation: Service de Cardiologie, CIC-IT 804, LISI INSERM U642, CHU Pontchaillou, 35000 Rennes, France.
authors.forename: Magalie
authors.initials: M
authors.lastname: Daudin
authors.affiliation: Service de Cardiologie, CIC-IT 804, LISI INSERM U642, CHU Pontchaillou, 35000 Rennes, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Fournet
authors.affiliation: Service de Chirurgie Cardio-Thoracique et Vasculaire, CHU Pontchaillou, 35000 Rennes, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Leguerrier
authors.affiliation: Service de Chirurgie Cardio-Thoracique et Vasculaire, CHU Pontchaillou, 35000 Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Flecher
authors.affiliation: INSERM, UMR 1099, 35000 Rennes, France LTSI, Université de Rennes 1, 35000 Rennes, France Service de Cardiologie, CIC-IT 804, LISI INSERM U642, CHU Pontchaillou, 35000 Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mabo
authors.affiliation: INSERM, UMR 1099, 35000 Rennes, France LTSI, Université de Rennes 1, 35000 Rennes, France Service de Cardiologie, CIC-IT 804, LISI INSERM U642, CHU Pontchaillou, 35000 Rennes, France erwan.donal@chu-rennes.fr.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015995:Prevalence; D011379:Prognosis; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*
keywords: Aortic stenosis; Cardiovascular mortality; Right ventricle