The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Increased mortality among patients with higher right ventricular volumes: Volumetric analysis of pre-trans-catheter aortic valve replacement CT Angiography

DOI: 10.4244/EIJ-D-19-00651

1. Department of Cardiology, Tel Aviv Medical affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Isreal, Israel
2. Department of Radiology, Stanford University School of Medicine, Stanford, California, U.S.A; Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm Sweden.
3. Department of Radiology, Tel Aviv Medical Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
4. Department of Cardiology, Tel Aviv Medical Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
5. Department of Cardiology, Tel Aviv Medical Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
6. Department of Cardiology, Tel Aviv Medical Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
7. Department of Cardiology, Tel Aviv Medical Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
8. Department of Cardiology, Tel Aviv Medical Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
9. Department of Cardiology, Hadassah Medical Center, Jerusalem, affiliated to the Hebrew University of Jerusalem, Jerusalem, Israel.
10. Department of Cardiology, Tel Aviv Medical Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
11. Internal Medicine, Tel Aviv Medical Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.Sourasky Tel Aviv Medical Center, Tel Aviv, Israel
12. Department of Radiology, Stanford University School of Medicine, Stanford, California, U.S.A.
13. Department of Radiology, Tel Aviv Medical Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Aims: To assess prognostic implications of increased right ventricle volume index (RVVI) using cardiac-gated computed tomography angiography (CCTA) data among patients undergoing trans-catheter valve implantation (TAVR). 

Methods and results: CCTA of 323 patients who underwent TAVR at Stanford University Medical Center (California, USA) and Tel Aviv Medical Center (Israel) between 2013-2016 were analyzed by an automatic 4-chamber volumetric software and grouped into quartiles according to their RVVI. Higher 1-year mortality rates were noted for the upper quartiles – 5%, 4.9%, 8.6%, and 16% (p=0.039), in Q1<59 ml/m2, Q2 59-69 ml/m2, Q3 69-86 ml/m2, and Q4>83 ml/m2, respectively. However, the differences were not significant after propensity score adjustments. Sub-analyses of Q1 demonstrated an escalating risk for 1-year mortality in concordance to RVVI; HR 2.28, HR 2.76, and HR 4.7, for the upper 25th, 15th, and 5th percentiles, respectively (p<0.05 for all comparisons). After propensity score adjustments for clinical and echocardiographic characteristics only the upper 5th percentiles (RVVI>120 ml/m2) retained statistical significance (HR 2.82, 95% CI 1.02-7.78, p=0.045). Notably, 68.7% of patients from this group were considered low-intermediate risk for surgery. 

Conclusions: Cardiac volumetric data by CCTA performed for procedural planning may help predict outcome in patients undergoing TAVR.

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