AUTHOR=Schmid Johannes , Kamml Claus , Zweiker David , Hatz Dominik , Schmidt Albrecht , Reiter Ursula , Toth Gabor G. , Fuchsjäger Michael , Zirlik Andreas , Binder Josepha S. , Rainer Peter P. 

TITLE=Cardiac Magnetic Resonance Imaging Right Ventricular Longitudinal Strain Predicts Mortality in Patients Undergoing TAVI

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.644500

DOI=10.3389/fcvm.2021.644500

ISSN=2297-055X

ABSTRACT=Background: Right ventricular (RV) function predicts survival in numerous cardiac conditions, including left heart disease. The reference standard for non-invasive assessment of RV function is CMR. The aim of this study was to investigate the association between pre-procedural cardiac magnetic resonance imaging (CMR) derived RV functional parameters and mortality in patients undergoing transcatheter aortic valve implantation (TAVI).
Methods: Patients scheduled for TAVI were recruited to undergo pre-procedural CMR. Volumetric function and global longitudinal and circumferential strain (GLS, GCS) of the RV and left ventricle (LV) were measured. The association with the primary endpoint (one-year all-cause mortality) was analyzed with Cox-Regression.
Results: Of 133 patients undergoing CMR 113 patients were included in the analysis. Mean age was 81.8±5.8 years, 65% were female. Median follow-up was 3.9 [IQR 2.3-4.7] years. All-cause and cardiovascular mortality was 14% and 12% at 1 year, and 28% and 20% at 3 years, respectively. One-year all-cause mortality was significantly predicted by RV GLS (HR=1.109 (95% CI: 1.023-1.203); p=0.012), RV ejection fraction (HR=0.956 (95% CI: 0.929-0.985); p=0.003), RV end-diastolic volume index (HR=1.009 (95% CI: 1.001-1.018); p=0.025), and RV end-systolic volume index (HR=1.010 (95% CI: 1.003-1.017); p=0.005). In ROC analysis for one-year all-cause mortality the area under the curve was 0.705 (RV GLS) and 0.673 (RV EF). Associations decreased in strength at longer follow-up. None of the LV parameters was associated with mortality. 
Conclusions: RV GLS is an independent predictor of intermediate term mortality in TAVI patients while LV parameters were not associated with outcomes. Inclusion of RV GLS may improve future risk scores.