Prognostic value of preprocedural right ventricular free-wall longitudinal strain for one-year mortality after transcatheter aortic valve implantation

TAVI has improved outcomes in severe AS, yet residual mortality risk remains. Current risk models primarily rely on left ventricular parameters, with limited incorporation of right ventricular function. To evaluate the prognostic value of preprocedural RV-FWLS for 1-year mortality after TAVI and its incremental value beyond conventional risk models. This single-center retrospective cohort study included 362 consecutive patients with severe AS who underwent TAVI. Preprocedural RV-FWLS was assessed using two-dimensional speckle-tracking echocardiography. The primary endpoint was 1-year all-cause mortality, with causes of death adjudicated as cardiovascular or non-cardiovascular. Multivariable Cox proportional hazards regression was performed to assess the independent association between RV-FWLS and mortality. Incremental prognostic value was evaluated using changes in the C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI), with 95% confidence intervals (CIs) estimated via bootstrap resampling. Receiver operating characteristic (ROC) analysis was performed to determine the optimal RV-FWLS cutoff value. During 1-year follow-up, 34 patients (9.4%) died, of whom 23 (67.6%) died from cardiovascular causes and 11 (32.4%) from non-cardiovascular causes. Patients with RV-FWLS > − 16.0% had higher mortality than those with RV-FWLS ≤ − 16.0% (log-rank P < 0.001). RV-FWLS remained independently associated with mortality after multivariable adjustment (per 1%-point increase in the signed RV-FWLS value: HR 1.11, 95% CI 1.04–1.18; P = 0.002). Adding RV-FWLS to the conventional risk model improved discrimination (C-statistic from 0.72 to 0.75; ΔC = 0.03, P = 0.01), with significant improvements in NRI (0.21, 95% CI 0.07–0.35; P = 0.004) and IDI (0.028, 95% CI 0.008–0.048; P = 0.008). ROC analysis showed an AUC of 0.78 (95% CI 0.71–0.85), with an exploratory cutoff value of −15.2% (sensitivity 76.5%, specificity 72.3%). Preprocedural RV-FWLS independently predicts 1-year mortality after TAVI and provides incremental prognostic value beyond conventional models, though the optimal cutoff requires external validation before clinical implementation.