Right ventricular dysfunction by computed tomography associates with outcomes in severe aortic stenosis patients undergoing transcatheter aortic valve replacement.

Background: Although cardiac computed tomography angiography (CCTA) assessment of right ventricular dysfunction (RVD) is feasible, the incremental prognostic value remains uncertain in patients undergoing transcatheter aortic valve replacement (TAVR) evaluation. This study sought to determine the incremental clinical utility of RVD identification by CCTA while accounting for clinical and echocardiographic parameters.
Methods: Patients who underwent multiphasic ECG-gated functional CCTA using dual-source system for routine TAVR planning were evaluated. Biphasic contrast protocol injection allowed for biventricular contrast enhancement. CCTA-based RVD was defined as right ventricular ejection fraction (RVEF) ​< ​50%. The association of CCTA-RVD with all-cause mortality and the composite outcome of death or heart failure hospitalization after TAVR was evaluated and examined for its incremental utility beyond clinical risk assessment and echocardiographic parameters.
Results: A total of 502 patients were included (median [IQR] age, 82 [77 to 87] years; 56% men) with a median follow-up of 22 [16 to 32] months. Importantly, 126 (25%) patients were identified as having RVD by CCTA that was not identified by echocardiography. CCTA-defined RVD predicted death and the composite outcome in both univariate analyses (HR for mortality, 2.15; 95% CI, 1.44-3.22; p ​< ​0.001; HR for composite outcome, 2.11; 95% CI, 1.48-3.01; p ​< ​0.001) and in multivariate models that included clinical risk factors and echocardiographic findings (HR for mortality, 1.74; 95% CI, 1.11-2.74; p ​= ​0.02; HR for composite outcome, 1.63; 95% CI, 1.09-2.44; p ​= ​0.02).
Conclusions: Functional CCTA assessment pre-TAVR correctly identified 25% of patients with RVD that was not evident on 2D echocardiography. The presence of RVD on CCTA independently associates with clinical outcomes post-TAVR.
Competing Interests: Declaration of competing interest Dr. Cavalcante has received consulting fees from Boston Scientific and Abbott Vascular; has received research grant support from Circle Cardiovascular Imaging, Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott Vascular; and has been a speaker for Medtronic, Circle Cardiovascular Imaging, and Siemens Healthineers. Dr. Sorajja has received consulting fees from Abbott Structural, Medtronic, Boston Scientific, Edwards Lifesciences Admedus, Gore and Teleflex; has received research grant support from Abbott Structural, Medtronic and Boston Scientific, and has been a speaker for Abbott Structural. Dr. Garcia is a consultant for Medtronic, Edwards Lifesciences, and Abbott Vascular. Institutional research grants from Edwards Lifesciences, Abbott vascular, Gore and BSCI. Proctor for Edwards Lifesciences. Dr. Gössl has received consulting fees from Abbott Vascular and Edwards Lifesciences.
(Copyright © 2021 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)