Measures of right ventricular function after transcatheter versus surgical aortic valve replacement

Lars Grønlykke; Nikolaj Ihlemann; Anh Thuc Ngo; Hans Gustav Hørsted Thyregod; Jesper Kjaergaard; André Korshin; Finn Gustafsson; Christian Hassager; Jens Christian Nilsson; Lars Søndergaard; Hanne Berg Ravn

doi:10.1093/icvts/ivw350

Measures of right ventricular function after transcatheter versus surgical aortic valve replacement

Lars Grønlykke, Nikolaj Ihlemann, Anh Thuc Ngo, Hans Gustav Hørsted Thyregod, Jesper Kjaergaard, André Korshin, Finn Gustafsson, Christian Hassager, Jens Christian Nilsson, Lars Søndergaard, Hanne Berg Ravn

Department of Clinical Medicine

15 Citations (Scopus)

Abstract

OBJECTIVES: Describe changes in measures of right ventricular (RV) function in patients treated for aortic stenosis using open-chest surgery (SAVR) or transcatheter treatment (TAVR). METHODS: Patients in the Nordic Aortic Valve Intervention (NOTION) trial were randomized 1:1 to TAVR (n = 114) or SAVR (n = 106). Echocardiography was performed at baseline and 3 and 12 months post-procedure. Tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC) were used as measures of longitudinal and transverse RV contraction. Left ventricular ejection fraction (LVEF) and LV atrioventricular plane displacement (AVPD) were recorded as measures of LV function. Association to NYHA class was examined. RESULTS: There were no differences in echocardiographic measurements between TAVR and SAVR at baseline. In the SAVR group, TAPSE was reduced after 3 months (2.4 ± 0.5 cm vs 1.6 ± 0.4 cm; P < 0.001), and 12 months (2.4 ± 0.5 cm vs 1.7 ± 0.4 cm; P < 0.001). RVFAC was reduced after 3 months (44% ± 11% vs 39% ± 10%; P = 0.001), but recovered at 12 months (43% ± 10%; P = 0.39). AVPD lateral increased during follow-up (1.4 ± 0.3 cm vs 1.6 ± 0.4 cm (P = 0.001) and 1.7 ± 0.4 cm, respectively; P < 0.001), whereas AVPD medial remained stable (baseline vs 3 months: P = 0.06 and baseline vs 12 months: P = 0.59). In the TAVR group, all echocardiographic measures remained unchanged from baseline to 12 months postoperatively. We found no association between echocardiographic changes and NYHA class. CONCLUSIONS: TAPSE and AVPD lateral differed between TAVR and SAVR at 3 and 12 months follow-up, but these findings were not related to any changes in NYHA class. These observations indicate that following SAVR, echocardiographic changes may not reflect right ventricular function, but merely a change in the physiological conditions. CLINICALTRIALS.GOV IDENTIFIER: NCT01057173.

Original language	English
Journal	Interactive Cardiovascular and Thoracic Surgery
Volume	24
Issue number	2
Pages (from-to)	181-187
Number of pages	7
ISSN	1569-9293
DOIs	https://doi.org/10.1093/icvts/ivw350
Publication status	Published - 1 Feb 2017

Keywords

Journal Article

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Grønlykke, L., Ihlemann, N., Ngo, A. T., Thyregod, H. G. H., Kjaergaard, J., Korshin, A., Gustafsson, F., Hassager, C., Nilsson, J. C., Søndergaard, L., & Ravn, H. B. (2017). Measures of right ventricular function after transcatheter versus surgical aortic valve replacement. Interactive Cardiovascular and Thoracic Surgery, 24(2), 181-187. https://doi.org/10.1093/icvts/ivw350

Grønlykke, L, Ihlemann, N, Ngo, AT, Thyregod, HGH, Kjaergaard, J, Korshin, A, Gustafsson, F , Hassager, C, Nilsson, JC, Søndergaard, L & Ravn, HB 2017, 'Measures of right ventricular function after transcatheter versus surgical aortic valve replacement', Interactive Cardiovascular and Thoracic Surgery, vol. 24, no. 2, pp. 181-187. https://doi.org/10.1093/icvts/ivw350

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title = "Measures of right ventricular function after transcatheter versus surgical aortic valve replacement",

abstract = "OBJECTIVES: Describe changes in measures of right ventricular (RV) function in patients treated for aortic stenosis using open-chest surgery (SAVR) or transcatheter treatment (TAVR). METHODS: Patients in the Nordic Aortic Valve Intervention (NOTION) trial were randomized 1:1 to TAVR (n = 114) or SAVR (n = 106). Echocardiography was performed at baseline and 3 and 12 months post-procedure. Tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC) were used as measures of longitudinal and transverse RV contraction. Left ventricular ejection fraction (LVEF) and LV atrioventricular plane displacement (AVPD) were recorded as measures of LV function. Association to NYHA class was examined. RESULTS: There were no differences in echocardiographic measurements between TAVR and SAVR at baseline. In the SAVR group, TAPSE was reduced after 3 months (2.4 ± 0.5 cm vs 1.6 ± 0.4 cm; P < 0.001), and 12 months (2.4 ± 0.5 cm vs 1.7 ± 0.4 cm; P < 0.001). RVFAC was reduced after 3 months (44% ± 11% vs 39% ± 10%; P = 0.001), but recovered at 12 months (43% ± 10%; P = 0.39). AVPD lateral increased during follow-up (1.4 ± 0.3 cm vs 1.6 ± 0.4 cm (P = 0.001) and 1.7 ± 0.4 cm, respectively; P < 0.001), whereas AVPD medial remained stable (baseline vs 3 months: P = 0.06 and baseline vs 12 months: P = 0.59). In the TAVR group, all echocardiographic measures remained unchanged from baseline to 12 months postoperatively. We found no association between echocardiographic changes and NYHA class. CONCLUSIONS: TAPSE and AVPD lateral differed between TAVR and SAVR at 3 and 12 months follow-up, but these findings were not related to any changes in NYHA class. These observations indicate that following SAVR, echocardiographic changes may not reflect right ventricular function, but merely a change in the physiological conditions. CLINICALTRIALS.GOV IDENTIFIER: NCT01057173.",

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author = "Lars Gr{\o}nlykke and Nikolaj Ihlemann and Ngo, {Anh Thuc} and Thyregod, {Hans Gustav H{\o}rsted} and Jesper Kjaergaard and Andr{\'e} Korshin and Finn Gustafsson and Christian Hassager and Nilsson, {Jens Christian} and Lars S{\o}ndergaard and Ravn, {Hanne Berg}",

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T1 - Measures of right ventricular function after transcatheter versus surgical aortic valve replacement

AU - Grønlykke, Lars

AU - Ihlemann, Nikolaj

AU - Ngo, Anh Thuc

AU - Thyregod, Hans Gustav Hørsted

AU - Kjaergaard, Jesper

AU - Korshin, André

AU - Gustafsson, Finn

AU - Hassager, Christian

AU - Nilsson, Jens Christian

AU - Søndergaard, Lars

AU - Ravn, Hanne Berg

PY - 2017/2/1

Y1 - 2017/2/1

N2 - OBJECTIVES: Describe changes in measures of right ventricular (RV) function in patients treated for aortic stenosis using open-chest surgery (SAVR) or transcatheter treatment (TAVR). METHODS: Patients in the Nordic Aortic Valve Intervention (NOTION) trial were randomized 1:1 to TAVR (n = 114) or SAVR (n = 106). Echocardiography was performed at baseline and 3 and 12 months post-procedure. Tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC) were used as measures of longitudinal and transverse RV contraction. Left ventricular ejection fraction (LVEF) and LV atrioventricular plane displacement (AVPD) were recorded as measures of LV function. Association to NYHA class was examined. RESULTS: There were no differences in echocardiographic measurements between TAVR and SAVR at baseline. In the SAVR group, TAPSE was reduced after 3 months (2.4 ± 0.5 cm vs 1.6 ± 0.4 cm; P < 0.001), and 12 months (2.4 ± 0.5 cm vs 1.7 ± 0.4 cm; P < 0.001). RVFAC was reduced after 3 months (44% ± 11% vs 39% ± 10%; P = 0.001), but recovered at 12 months (43% ± 10%; P = 0.39). AVPD lateral increased during follow-up (1.4 ± 0.3 cm vs 1.6 ± 0.4 cm (P = 0.001) and 1.7 ± 0.4 cm, respectively; P < 0.001), whereas AVPD medial remained stable (baseline vs 3 months: P = 0.06 and baseline vs 12 months: P = 0.59). In the TAVR group, all echocardiographic measures remained unchanged from baseline to 12 months postoperatively. We found no association between echocardiographic changes and NYHA class. CONCLUSIONS: TAPSE and AVPD lateral differed between TAVR and SAVR at 3 and 12 months follow-up, but these findings were not related to any changes in NYHA class. These observations indicate that following SAVR, echocardiographic changes may not reflect right ventricular function, but merely a change in the physiological conditions. CLINICALTRIALS.GOV IDENTIFIER: NCT01057173.

AB - OBJECTIVES: Describe changes in measures of right ventricular (RV) function in patients treated for aortic stenosis using open-chest surgery (SAVR) or transcatheter treatment (TAVR). METHODS: Patients in the Nordic Aortic Valve Intervention (NOTION) trial were randomized 1:1 to TAVR (n = 114) or SAVR (n = 106). Echocardiography was performed at baseline and 3 and 12 months post-procedure. Tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC) were used as measures of longitudinal and transverse RV contraction. Left ventricular ejection fraction (LVEF) and LV atrioventricular plane displacement (AVPD) were recorded as measures of LV function. Association to NYHA class was examined. RESULTS: There were no differences in echocardiographic measurements between TAVR and SAVR at baseline. In the SAVR group, TAPSE was reduced after 3 months (2.4 ± 0.5 cm vs 1.6 ± 0.4 cm; P < 0.001), and 12 months (2.4 ± 0.5 cm vs 1.7 ± 0.4 cm; P < 0.001). RVFAC was reduced after 3 months (44% ± 11% vs 39% ± 10%; P = 0.001), but recovered at 12 months (43% ± 10%; P = 0.39). AVPD lateral increased during follow-up (1.4 ± 0.3 cm vs 1.6 ± 0.4 cm (P = 0.001) and 1.7 ± 0.4 cm, respectively; P < 0.001), whereas AVPD medial remained stable (baseline vs 3 months: P = 0.06 and baseline vs 12 months: P = 0.59). In the TAVR group, all echocardiographic measures remained unchanged from baseline to 12 months postoperatively. We found no association between echocardiographic changes and NYHA class. CONCLUSIONS: TAPSE and AVPD lateral differed between TAVR and SAVR at 3 and 12 months follow-up, but these findings were not related to any changes in NYHA class. These observations indicate that following SAVR, echocardiographic changes may not reflect right ventricular function, but merely a change in the physiological conditions. CLINICALTRIALS.GOV IDENTIFIER: NCT01057173.

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DO - 10.1093/icvts/ivw350

M3 - Journal article

C2 - 27811168

SN - 1569-9285

VL - 24

SP - 181

EP - 187

JO - Interdisciplinary cardiovascular and thoracic surgery

JF - Interdisciplinary cardiovascular and thoracic surgery

IS - 2

ER -

Measures of right ventricular function after transcatheter versus surgical aortic valve replacement

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