BACKGROUND Pulmonary hypertension is an established outcome predictor in patients with aortic stenosis (AS), but the prognostic impact of right ventricular dysfunction has not been well studied. METHODS We included 2181 patients (50.4% men; mean age, 77 years) with aortic valve area <1.3 cm2 and analyzed the occurrence of all-cause death during follow-up according to tricuspid annular plane systolic excursion (TAPSE) quartiles. RESULTS Patients in the lowest quartile (TAPSE <17 mm) were at a high risk of death, whereas survival was comparable for the 3 other quartiles. Five-year survival was 55±2% for TAPSE <17 mm, 72±2% for TAPSE of 17 to 20 mm, 71±2% for TAPSE of 20 to 24 mm, and 73±2% for TAPSE >24 mm (overall P<0.001). TAPSE <17 mm was associated with increased mortality after adjustment for established prognostic factors (adjusted hazard ratio [HR], 1.55 [95% CI, 1.21-1.97]) and after further adjustment for aortic valve replacement (AVR; adjusted HR, 1.47 [95% CI, 1.15-1.87]). The excess mortality risk associated with TAPSE <17 mm was noticed in both patients managed initially conservatively (adjusted HR, 1.46 [95% CI, 1.20-1.76]) and patients who underwent early (within 3 months after diagnosis) AVR (adjusted HR, 1.61 [95% CI, 1.03-2.52]). In asymptomatic patients with severe AS and preserved ejection fraction, TAPSE <17 mm was independently predictive of mortality (adjusted HR, 2.14 [95% CI, 1.31-3.51]). Early AVR was associated with similar survival benefit in TAPSE <17 and ≥17 mm (adjusted HR, 0.23 [95% CI, 0.16-0.34] for TAPSE <17 mm, adjusted HR, 0.26 [95% CI, 0.19-0.35] for TAPSE ≥17 mm; P for interaction, 0.97). CONCLUSIONS Right ventricular dysfunction is an important and independent predictor of mortality in AS. TAPSE <17 mm at the time of AS diagnosis is a marker of poor survival under conservative management and after AVR even in asymptomatic patients with severe AS. AVR was associated with a pronounced reduction in mortality independent of TAPSE suggesting that AVR should be discussed before right ventricular dysfunction occurs in severe AS.

中文翻译：

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右心室收缩功能障碍对主动脉瓣狭窄结果的影响。

背景技术肺动脉高压是主动脉瓣狭窄（AS）患者的既定预后指标，但对右心室功能障碍的预后影响尚未得到很好的研究。方法我们纳入了2181例主动脉瓣面积＜1.3 cm2的患者（男性50.4％；平均年龄77岁），并根据三尖瓣环平面收缩期偏移（TAPSE）四分位数分析了随访期间全因死亡的发生情况。结果处于最低四分位数（TAPSE <17毫米）的患者有较高的死亡风险，而其他三个四分位数的生存率却相当。TAPSE <17 mm的五年生存率为55±2％，TAPSE为17至20 mm的为72±2％，TAPSE为20至24 mm的为71±2％，TAPSE> 24 mm的为73±2％（总体P <0.001）。TAPSE < 调整既定的预后因素（调整的危险比[HR]，1.55 [95％CI，1.21-1.97]）以及进一步调整主动脉瓣置换（AVR；调整后的HR，1.47 [95％]后，17 mm与死亡率增加相关CI，1.15-1.87]）。最初接受保守治疗（校正后的HR，1.46 [95％CI，1.20-1.76]）和早期（诊断后3个月内）进行AVR（校正后的HR， 1.61 [95％CI，1.03-2.52]。在无症状的严重AS患者和射血分数保持不变的患者中，TAPSE <17 mm可独立预测死亡率（校正后的HR，2.14 [95％CI，1.31-3.51]）。TAPSE <17 mm或≥17mm时，早期AVR与类似的生存获益相关（TAPSE <17 mm HR调整后HR为0.23 [95％CI，0.16-0.34]，HR调整为0。TAPSE≥17mm时为26 [95％CI，0.19-0.35]；P表示互动，0.97）。结论右心室功能障碍是AS死亡率的重要且独立的预测指标。AS诊断时的TAPSE <17 mm是保守治疗和AVR后甚至严重AS患者的无症状患者生存不良的标志。与TAPSE无关，AVR可使死亡率显着降低，这提示在严重AS发生右心室功能障碍之前应讨论AVR。