Prognostic impact of right ventricular dysfunction in patients with severe aortic stenosis treated with trans-catheter aortic valve implantation: comment and validation from a small real-world cohort.

Abstract

Right ventricular dysfunction is a known predictor of early mortality after TAVI. TAPSE is a practical echocardiographic index of RV function. To assess whether baseline TAPSE predicts 30-day mortality after TAVI in a real-world cohort. Among 21 patients, those with TAPSE < 17 mm had higher 30-day mortality (28.6% vs 7.1%). PASP was higher in the low-TAPSE group (45 ± 12 vs 32 ± 10 mmHg; p = 0.03). Non-survivors had a lower TAPSE/PASP ratio than survivors (median 0.351 [IQR 0.288-0.419] vs 0.607 [0.406-0.667]; exact p = 0.078), in line with a trend toward worse RV-pulmonary arterial coupling. A multivariable model including TAPSE, age, and EuroSCORE II showed apparent perfect discrimination (AUC = 1.00) within this very small dataset (3 events), likely overestimating true performance due to overfitting. TAPSE may serve as a simple, effective tool for early risk stratification in TAVI candidates as an adjunct to-rather than a replacement for-comprehensive geriatric/frailty assessment and established risk scores; estimates are unstable due to the small sample and event count.