Tricuspid annular dilation (TAD) may be an independent predictor of all-cause mortality after transcatheter aortic valve replacement (TAVR) for severe aortic stenosis, according to a study published in the Journal of the American College of Cardiologists: Cardiovascular Interventions.

A total of 1137 patients (mean age, 80.6±7.6 years; 48.5% men) undergoing transfemoral TAVR at the Munich University Hospital between 2013 and 2016 were enrolled. Patients underwent computed tomography prior to TAVR and were assessed at 24 hours, 30 days, and at a median of 1.8 year (interquartile range [IQR], 1.2-2.5 years) for cardiovascular health and instance of mortality.

In this cohort, 63.5% of patients had comorbid coronary artery disease, 14.3% had a prior cardiac surgery, average aortic valve area was 0.75±0.2 cm2, and mean pressure gradient was 37.7±14.0 mmHg.

Before the procedure, the tricuspid annular had the following median values indexed to body surface area for this cohort: septolateral diameter, 22.1 mm/m2 (IQR, 19.7-24.9 mm/m2); cranial-caudal diameter, 22.6 mm/m2 (IQR, 19.6-25.3 mm/m2); area, 749 mm/m2 (IQR, 631-873 mm/m2); right atrial area, 1368 mm/m2 (IQR, 1163-1465 mm/m2); right ventricular length, 35.7 mm/m2 (IQR, 31.0-41.0 mm/m2); and right ventricular midventricular diameter, 16.4 mm/m2 (IQR, 13.9-18.9) mm/m2).


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Using a receiver-operating characteristic (ROC) curve analysis, 23 mm/m2 was determined as the best cutoff for TAD, over which mortality was increased. Patients with (39.2%) vs without TA dilation differed significantly in: age (P <.001), body mass index (P <.001), rates of atrial fibrillation (P <.001), hypercholesterolemia (P <.001), prior aortic valve replacement (P <.01), and impaired left (P <.01) and right (P <.001) ventricular functions.

Although balloon-expandable valves were implanted in 82% of patients, predilation was more common in patients with normal vs dilated tricuspid annular (89.7% vs 82.3%, respectively; P <.01). TAD was not associated with acute stroke (P =1.00), device failure (P =.35), procedural mortality (P =.22), pacemaker implantation (P =.10), or acute myocardial infarction (P =.10).

At the study conclusion, 299 patients had died. TAD was associated with increased instance of mortality (hazard ratio [HR], 1.99; 95% CI, 1.59-2.51; P <.001). Patients with and without TAD had survival rates of 78.3% (95% CI, 74.6%-82.3%) and 88.7% (95% CI, 86.4%-91.1%), respectively at 1-year and 67.4% (95% CI, 62.9%-72.2%) and 81.7% (95% CI, 78.7%-84.8%) at 2-years, respectively.

Compared with established biomarkers for mortality, TAD was the second highest independent predictor of mortality, with an additive predictive value of 0.204 (95% CI, 0.101-0.288; P <.01).

This study was limited by the absence of validation with an independent cohort.

The study authors concluded that TAD is common among patients with severe aortic stenosis undergoing TAVR and represents a strong independent predictor of mortality.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Deseive S, Steffen J, Beckmann M, et al. CT-determined tricuspid annular dilatation is associated with increased 2-year mortality in TAVR patients. JACC Cardiovasc Interv. 2020;S1936-8798(20)31377-7. doi:10.1016/j.jcin.2020.06.027