A novel speckle-tracking index for predicting mortality following transcatheter aortic valve replacement

Yuanqi Yang; Xi Li; Wenxia Zhou; Yuyan Cai; Yujia Liang; Zhengang Zhao; Qiao Li; Jiafu Wei; Yong Peng; Wei Meng; Yuan Feng; Hong Tang; Xin Wei; Mao Chen

doi:10.21037/qims-2025-1-2713

A novel speckle-tracking index for predicting mortality following transcatheter aortic valve replacement

Quant Imaging Med Surg. 2026 Jun 1;16(6):455. doi: 10.21037/qims-2025-1-2713. Epub 2026 May 12.

Authors

Yuanqi Yang^{1

2

3}, Xi Li^{1

2

3}, Wenxia Zhou², Yuyan Cai², Yujia Liang², Zhengang Zhao^{1

2

3}, Qiao Li², Jiafu Wei², Yong Peng^{1

2

3}, Wei Meng⁴, Yuan Feng², Hong Tang², Xin Wei^{1

2

3}, Mao Chen^{1

2

3}

Affiliations

¹ Laboratory of Cardiac Structure and Function, Institute of Cardiovascular Diseases, West China Hospital, Sichuan University, Chengdu, China.
² Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
³ Cardiac Structure and Function Research Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
⁴ Department of Cardiac Surgery, West China Hospital, Sichuan University, Chengdu, China.

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.

Keywords: Right ventricular dyssynchrony (RV dyssynchrony); aortic stenosis (AS); mortality; speckle-tracking; transcatheter aortic valve replacement (TAVR).