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

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

doi:10.3389/fcvm.2021.644500

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

Front Cardiovasc Med. 2021 May 7:8:644500. doi: 10.3389/fcvm.2021.644500. eCollection 2021.

Authors

Affiliations

¹ Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
² Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
³ Third Medical Department of Cardiology and Intensive Care, Wilhelminenhospital, Vienna, Austria.
⁴ BioTechMed Graz, Graz, Austria.

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 cardiac magnetic resonance imaging (CMR). The aim of this study was to investigate the association between pre-procedural 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 and GCS) of the RV and left ventricle (LV) were measured. The association with the primary endpoint (1-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, and 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 receiver operating characteristic (ROC) analysis for 1-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 function predicts intermediate-term mortality in TAVI patients while LV parameters were not associated with outcomes. Inclusion of easily obtainable RV GLS may improve future risk scores.

Keywords: MRI; aortic valve stenosis; magnetic resonance imaging; mortality; right ventricular function; strain; survival analysis; transcatheter aortic valve implantation.