Prevalence and determinants or right ventricular dysfunction in severe aortic stenosis

Introduction Systolic pulmonary artery pressure (sPAP) is a well-known predictor of outcome in patients with valvular heart disease. In spite of this fact, limited data are available regarding the assessment of RV function in patients with aortic stenosis (AS). Aim of this study is therefore to evaluate the prevalence and the determinants of RV dysfunction in severe AS patients Methods 301 patients (mean age: 79.7 ± 8.7, male sex 55.5%) with severe AS underwent 2D echocardiography and speckle tracking echocardiography (STE) for the evaluation of left ventricular and RV function, aortic valve gradients and sPAP. A tricuspid annular plane systolic excursion (TAPSE) ≤ 17 mm was used to define reduced RV ventricular function. Results RV function was impaired in 24% of patients (patients with reduced TAPSE had an impaired LV ejection fraction (LVEF) (49.2 ± 15.4 vs. 57.9 ± 10.9%, P P P  = 0.002) with respec to patients with a normal RV function. Correlates of a reduced TAPSE were: LVEF ( β  = 0.35, P β  = −0.40, β  = −0.40, β  = 0.37 respectively, all P β  = 0.44, s β  = −0.51, P β  = −0.27, P P  = 0.034). Conclusions In patients with severe AS, RV function impairment is frequent and is associated with a poor prognosis. The correlations of TAPSE highlight the RV-LV interdependence in AS patients. Further studies will clarify the real and independent prognostic value of RV function in severe AS patients and test for the RV reverse remodelling after treatment of the AS.