Left and right ventricular longitudinal systolic function following aortic valve replacement in the PARTNER 2 trial and registry

Abstract

Abstract Aims Evaluation of left and right ventricular (RV) longitudinal systolic function may enhance risk stratification following aortic valve replacement (AVR). The study objective was to evaluate the changes in left and RV longitudinal systolic function and RV–pulmonary artery (RV–PA) coupling from baseline to 30 days and 1 year after AVR. Methods and results Left ventricular (LV) longitudinal strain (LS), tricuspid annulus plane systolic excursion (TAPSE), and RV–PA coupling were evaluated in patients from the PARTNER 2A surgical AVR (SAVR) arm (n = 985) and from the PARTNER 2 SAPIEN 3 registry (n = 719). TAPSE and RV–PA coupling decreased significantly following SAVR, but remained stable following TAVR. Lower LV LS, TAPSE, or RV–PA coupling at baseline was associated with increased risk of the composite of death, hospitalization, and stroke at 5 years [adjusted hazard ratios (HRs) for LV LS < 15%: 1.24, 95% confidence interval (CI) 1.05–1.45, P = 0.001; TAPSE < 14 mm: 1.44, 95% CI 1.21–1.73, P < 0.001; RV–PA coupling < 0.55 mm/mmHg: 1.32, 95% CI 1.07–1.63, P = 0.011]. Reduced TAPSE at baseline was the most powerful predictor of the composite endpoint at 5 years. Patients with LV ejection fraction <50% at baseline had increased risk of the primary endpoint with SAVR (HR: 1.34, 95% CI 1.08–1.68, P = 0.009) but not with TAVR (HR: 1.12, 95% CI 0.88–1.42). Lower RV–PA coupling at 30 days showed the strongest association with cardiac mortality. Conclusion SAVR but not TAVR was associated with a marked deterioration in RV longitudinal systolic function and RV–PA coupling. Lower TAPSE and RV–PA coupling at 30 days were associated with inferior clinical outcomes at 5 years. In patients with LVEF < 50%, TAVR was associated with superior 5-year outcomes.