BACKGROUND Conventional right ventricular (RV) echocardiographic measurements of systolic function (SF) have demonstrated conflicting results when their association with long-term outcomes after transcatheter aortic valve replacement (TAVR) is evaluated. RV free-wall (FW) longitudinal strain (LS) is a novel, single parameter to measure RV SF and may provide a better evaluation than fractional area change, tricuspid annular plane systolic excursion, and myocardial velocity (S'). The value of RV FW LS in patients undergoing TAVR and its association with 1-year mortality are unknown. The aim of this study was to test the hypothesis that RV FW LS would be associated with 1-year all-cause mortality in patients undergoing TAVR. METHODS Consecutive patients who underwent TAVR between 2007 and 2014 in whom RV FW LS was measurable were included; a subgroup that had 1-year follow-up echocardiographic evaluation of RV FW LS was analyzed. FW LS was derived from speckle-tracking analyses. The standard reference was determined as normal or impaired RV SF, the latter defined as the presence of ≥50% of tricuspid annular plane systolic excursion < 1.7 cm, S' < 9.5 cm/sec, and fractional area change < 35%. Cox proportional-hazards regression analysis was used to assess the association of RV FW LS with 1-year all-cause mortality. RESULTS Of 612 patients, 334 were included for RV FW LS analysis on pre-TAVR echocardiography (feasibility 55%); exclusion criteria included atrial fibrillation (n = 92 [15%]), pacemaker (n = 73 [12%]), and poor image quality (n = 113 [18%]). Baseline impaired RV SF was present in 19% of cases. RV FW LS did not change significantly at 1-year follow-up, in both the groups with baseline impaired and normal function. Cox regression analysis showed that RV FW LS was associated with all-cause mortality at 1 year (hazard ratio, 1.06; 95% CI, 1.01-1.11). For each unit increase in RV FW LS, there was a 6% higher risk for 1-year mortality. CONCLUSIONS In a high-risk TAVR population, RV FW LS should be considered a single echocardiographic parameter for the assessment of RV SF. When measurable, RV FW LS is associated with all-cause mortality at 1 year after TAVR.

中文翻译：

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右心室纵向应变与接受经导管主动脉瓣置换术患者死亡率的关联。

背景 传统的右心室 (RV) 超声心动图测量收缩功能 (SF) 与评估经导管主动脉瓣置换术 (TAVR) 后长期结果的相关性，结果显示出相互矛盾的结果。RV 游离壁 (FW) 纵向应变 (LS) 是测量 RV SF 的一种新颖的单一参数，可以提供比面积变化、三尖瓣环平面收缩偏移和心肌速度 (S') 更好的评估。RV FW LS 在接受 TAVR 的患者中的价值及其与 1 年死亡率的关系尚不清楚。本研究的目的是检验 RV FW LS 与接受 TAVR 的患者 1 年全因死亡率相关的假设。方法 纳入 2007 年至 2014 年间接受 TAVR 且可测量 RV FW LS 的连续患者；分析了对 RV FW LS 进行 1 年随访超声心动图评估的亚组。FW LS 源自散斑跟踪分析。标准参考被确定为正常或受损的 RV SF，后者定义为存在≥50% 的三尖瓣环平面收缩偏移 < 1.7 cm、S' < 9.5 cm/sec 和分数面积变化 < 35%。Cox 比例风险回归分析用于评估 RV FW LS 与 1 年全因死亡率的关联。结果 在 612 名患者中，334 名被纳入对 TAVR 前超声心动图的 RV FW LS 分析（可行性 55%）；排除标准包括房颤（n = 92 [15%]）、起搏器（n = 73 [12%]）和图像质量差（n = 113 [18%]）。19% 的病例存在基线受损的 RV SF。RV FW LS 在 1 年的随访中没有显着变化，在基线受损和正常功能的两组中。Cox 回归分析显示 RV FW LS 与 1 年全因死亡率相关（风险比，1.06；95% CI，1.01-1.11）。RV FW LS 每增加一个单位，1 年死亡率的风险就会增加 6%。结论 在高危 TAVR 人群中，RV FW LS 应被视为评估 RV SF 的单一超声心动图参数。当可测量时，RV FW LS 与 TAVR 后 1 年的全因死亡率相关。RV FW LS 应被视为评估 RV SF 的单一超声心动图参数。当可测量时，RV FW LS 与 TAVR 后 1 年的全因死亡率相关。RV FW LS 应被视为评估 RV SF 的单一超声心动图参数。当可测量时，RV FW LS 与 TAVR 后 1 年的全因死亡率相关。