Evidence map›Paper›PMID 38887164›Full record

ArticleEuropean journal of heart failure2024

Right ventricular dysfunction and impaired right ventricular-pulmonary arterial coupling in paradoxical low-flow, low-gradient aortic stenosis.

Richard J Nies, Felix S Nettersheim, Simon Braumann, Svenja Ney, Laurin Ochs, Johannes Dohr, Jasper F Nies, Hendrik Wienemann, Matti Adam, Victor Mauri and 2 more

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Article in European journal of heart failure, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Richard J NiesDepartment of Cardiology, Heart Center, University of Cologne, Cologne, Germany.
Felix S NettersheimDepartment of Cardiology, Heart Center, University of Cologne, Cologne, Germany.
Simon BraumannDepartment of Cardiology, Heart Center, University of Cologne, Cologne, Germany.
Svenja NeyDepartment of Cardiology, Heart Center, University of Cologne, Cologne, Germany.
Laurin OchsDepartment of Cardiology, Heart Center, University of Cologne, Cologne, Germany.
Johannes DohrDepartment of Cardiology, Heart Center, University of Cologne, Cologne, Germany.
Jasper F NiesDepartment of Nephrology, University of Cologne, Cologne, Germany.
Hendrik WienemannDepartment of Cardiology, Heart Center, University of Cologne, Cologne, Germany.
Matti AdamDepartment of Cardiology, Heart Center, University of Cologne, Cologne, Germany.
Victor MauriDepartment of Cardiology, Heart Center, University of Cologne, Cologne, Germany.
Stephan BaldusDepartment of Cardiology, Heart Center, University of Cologne, Cologne, Germany.
Stephan RosenkranzDepartment of Cardiology, Heart Center, University of Cologne, Cologne, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsParadoxical low-flow, low-gradient aortic stenosis (pLFLG AS) may represent a diagnostic challenge, and its pathophysiology is complex. While left ventricular (LV) systolic function is preserved, right ventricular dysfunction (RVD) and consecutive LV underfilling may contribute to low-flow and reduced stroke volume index, and to adverse outcomes following transcatheter aortic valve implantation (TAVI). The aim of this study was to evaluate the potential role of RVD in pLFLG AS, and to assess the impact of pre-procedural RVD on clinical outcomes after TAVI in patients with pLFLG AS. METHODS AND

resultsOut of 2739 native AS patients, who received TAVI at the University of Cologne Heart Center between March 2013 and June 2021, 114 patients displayed pLFLG AS and were included in this study. Right ventricular (RV) function was assessed by transthoracic echocardiography, and a fractional area change (FAC) ≤35% and/or a tricuspid annular plane systolic excursion (TAPSE) <18 mm determined RVD. In addition, the TAPSE/systolic pulmonary artery pressure ratio (TAPSE/sPAP) was monitored as a measure of RV-pulmonary arterial (PA) coupling. An impaired FAC and TAPSE was present in 21.9% and 45.6% of patients, respectively, identifying RVD in 50.0%. RVD (p = 0.016), reduced FAC (p = 0.049), reduced TAPSE (p = 0.035) and impaired RV-PA coupling (TAPSE/sPAP ratio <0.31 mm/mmHg; p = 0.009) were associated with significantly higher all-cause mortality compared to patients with normal RV function. After adjustment for sex, age, body mass index, EuroSCORE II, previous myocardial infarction and mitral regurgitation, independent predictors for all-cause mortality were FAC, sPAP, TAPSE/sPAP ratio, right atrial area, RV diameter and tricuspid regurgitation.

conclusionsAdverse RV remodelling, RVD and impaired RV-PA coupling provide an explanation for low-flow and reduced stroke volume index in a subset of patients with pLFLG AS, and are associated with excess mortality after TAVI.

Indexed as

Aortic Valve StenosisPulmonary ArteryTranscatheter Aortic Valve ReplacementVentricular Dysfunction, RightAgedAged, 80 and overEchocardiographyFemaleHeart VentriclesHumansMaleRetrospective StudiesSeverity of Illness IndexStroke VolumeVentricular Function, RightAortic stenosisLow‐flow low‐gradientMortalityParadoxicalRight ventricular dysfunctionTranscatheter aortic valve implantation

Identifiers

PMID38887164
PMCPMC11659504

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.