title: Impact of Right Ventricular Dysfunction and Tricuspid Regurgitation on Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement.
abstract: Right ventricular (RV) dysfunction and tricuspid regurgitation (TR) may coexist with aortic stenosis. The aim of this study was to assess the association between RV dysfunction, TR, associated comorbidities, and outcomes following transcatheter aortic valve replacement (TAVR).
  
  
  
  A retrospective analysis was conducted of baseline and 6-month clinical and echocardiographic parameters, including TR grade, RV size (grade, end-diastolic and end-systolic areas, annular diameter), and function (grade, tricuspid annular plane systolic excursion [TAPSE], fractional area change, Tei index), in 519 consecutive TAVR patients.
  
  
  
  The prevalence of moderate or greater TR was 11% (n = 59). Although TR was associated with increased mortality (P = .02) in unadjusted analysis, it did not demonstrate an independent association with outcome when adjusted for RV dysfunction (TAPSE; P = .30) or multiple clinical parameters (P ≥ .20). RV parameters associated with poor outcomes included TAPSE (P = .006) and Tei index (P = .005). TAPSE was associated with lower survival even when adjusted for TR (P = .009) and all clinical parameters (P = .01). Persistence of moderate or greater TR 6 months after TAVR seemed to be associated with lower survival (P = .02), even when adjusted for clinical and RV parameters (P = .07).
  
  
  
  TR in association with aortic stenosis is frequently progressive despite TAVR but is not independently associated with outcomes. RV function is a stronger driver of adverse outcomes compared with TR itself, and RV quantitative rather than qualitative evaluation is the key to stratify these patients.
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Lorin Arie
authors.initials: LA
authors.lastname: Schwartz
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Zach
authors.initials: Z
authors.lastname: Rozenbaum
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Ehab
authors.initials: E
authors.lastname: Ghantous
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Judith
authors.initials: J
authors.lastname: Kramarz
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Simon
authors.initials: S
authors.lastname: Biner
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Ghermezi
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Jason
authors.initials: J
authors.lastname: Shimiaie
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Finkelstein
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Banai
authors.affiliation: Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Galit
authors.initials: G
authors.lastname: Aviram
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Meirav
authors.initials: M
authors.lastname: Ingbir
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: topilskyyan@gmail.com.
authors.forename: Yan
authors.initials: Y
authors.lastname: Topilsky
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D015984:Causality; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000517:prevention & control; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000517:prevention & control
keywords: Aortic stenosis; Prognosis; Transcatheter aortic valve replacement; Tricuspid annular plane systolic excursion; Tricuspid regurgitation