Results
Forty-eight patients were included with pre-implantation and
post-implantation catheterization data (Table 1). Of the 48 patients, 36
(77%) had CMR images available for analysis of RV mass (Table 2).
Higher RV mass indexed to BSA was associated with higher RVSP, with a
significantly higher average RV mass indexed seen with
RVSP> 75% compared to 0%-49% (+31.9 \(g/m^{2}\),
CI 7.5-56.4, p=0.012). There was no association between RVEF and
pre-implantation RVSP in this cohort (p=0.7).
Ventricular Longitudinal Strain versus Right Ventricular Systolic
Pressure Relationship
Elevated RVSP was significantly associated with a decrease in RV GLS,
with every 14.3% increase in RVSP above 28% associated with an
absolute magnitude 1% lower RV GLS at preimplantation (p=0.001). When
the average pre-implantation RV GLS in was split into 3 categories based
preimplantation RVSP: 0-49%, 50-74%, and >75%, the RV
GLS was an absolute magnitude of 3.4% lower in those with RVSP
>75% compared to 0%-49% (p=0.014). There was no
significant association between pre-implantation LV GLS and RVSP as a
continuous variable (p=0.141) or by RVSP categories
(> 75%, p=0.435).
Similar to the effect of
pre-implantation RVSP on strain, a 6.3% increase in RVSP above 28%
post TPVR was associated with an absolute magnitude 1% lower RV
longitudinal strain (p<0.001). Age was not associated with
significant change in RV (p=0.354) or LV GLS magnitude (p=0.235).
Overall, the RV GLS magnitude increased after TPVR from pre-implantation
over time, with the greatest improvement immediately after valve
implantation; however, on follow-up imaging performed within
18 months, the RV GLS was closer
to pre-implantation values. The same trend was visualized in LV GLS
strain magnitude over time (Figure 1). When categorized into 3 groups by
RVSPP (0%-49%, 50%-74%, > 75%), the average
strain value showed greatest improvement immediately post TPVR at
0%-49% compared to > 75% (Figure 2).
Pre-implantation Filling Pressure Effect on Ventricular Longitudinal
Strain
For every 1 mmHg higher
pre-implantation RVEDP, RV GLS absolute magnitude decreased by 0.26%
(p=0.04). The pre-implantation LVEDP was not significantly associated
with worsened LV GLS magnitude (p=0.788).