ArticleQuantitative imaging in medicine and surgery2026
A novel speckle-tracking index for predicting mortality following transcatheter aortic valve replacement.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: (TAVR) are associated with cardiac damage, especially in those with pulmonary hypertension (PH) and right ventricular (RV) dysfunction. RV dyssynchrony is a novel prognostic indicator in PH patients, but its prognostic value in TAVR patients is unclear. We aimed to assess the prognostic value of RV dyssynchrony in TAVR patients. Methods: A total of 1,052 consecutive patients with severe aortic stenosis (AS) undergoing TAVR between April 2012 and December 2021 were studied. The primary endpoint was 3-year mortality. RVSD4 was defined as the standard deviation of the times to peak-systolic strain for the four mid-basal RV segments by two-dimensional (2D) speckle-tracking echocardiography (STE), and RV dyssynchrony was defined as RVSD4 >18 ms. Results: After 3-year follow-up, 182 patients (17.3%) died. Compared with the survivors, the non-survivors were older, included less females, had more comorbidities, comprised more patients with a pacemaker and New York Heart Association (NYHA) functional class III/IV, had a higher Society of Thoracic Surgeons (STS) score, worse laboratory data, and worse cardiac function. Cox regression analysis showed NYHA functional class III/IV [hazard ratio (HR): 2.134, 95% confidence interval (CI): 1.193-3.816, P=0.011], estimated glomerular filtration rate (eGFR; HR: 0.990, 95% CI: 0.980-1.000, P=0.044), and RVSD4 (HR: 1.028, 95% CI: 1.024-1.032, P<0.001) were independent risk factors for the mortality of patients after TAVR, and the fully adjusted multivariable HR of RV dyssynchrony was 4.008 (95% CI: 2.541-6.323). Additionally, a graded association between RV dyssynchrony and mortality at 3 years (P<0.001) was robustly revealed by Kaplan-Meier analyses. Conclusions: RV dyssynchrony is an independent and robust risk factor for 3-year mortality in patients with severe AS undergoing TAVR, and RVSD4 can be utilized as a risk stratification tool to prognosticate the long-term mortality of those patients.
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