Impact of right heart function on outcome in patients with functional mitral regurgitation and chronic heart failure undergoing percutaneous edge‐to‐edge‐repair

Abstract

Aims: To evaluate the impact of right ventricular dysfunction (RVD) on outcome after transcatheter mitral valve repair (TMVR) in patients with chronic heart failure (CHF) and severe functional mitral regurgitation (FMR).Methods and Results: One hundred thirty patients (median age 72.7 ± 10.7 years; 63.8% male) at high operative risk (LogEuroSCORE 23.8 ± 13.9%) with FMR and CHF (left ventricular ejection fraction 32 ± 7%) were enrolled and separated into two groups according to the RVD. RVD was assessed by the tricuspid annular plane systolic excursion (TAPSE) method (A: TAPSE ≤ 16 mm, n = 58; B: TAPSE > 16 mm, n = 72). The rate of successful reduction of mitral regurgitation (MR ≤2+) by TMVR was similar in both groups (94.6% vs 91.2%; P: n.s.) with low in-hospital major adverse event rates.During a median follow-up period of 10.5 ± 4 months, the Kaplan-Meier analysis revealed a significantly higher all-cause mortality in group A (43.1% vs 23.6%; log-rank P = 0.039) and a significantly higher rate of hospital readmission due to congestive heart failure (56.9% vs 26.4%; log-rank P < 0.001). At long-term follow-up, 25% of patients in group A remained in NYHA functional class IV (none in group B). Preexisting RVD as assessed by TAPSE and Doppler tissue imaging (DTI-S') was an independent predictor of all-cause mortality after TMVR (hazard ratio 2.84; 95% confidence interval 1.15-7.65; P = 0.039; hazard ratio 4.70; 95% confidence interval 1.14-20.21; P = 0.044, respectively). Conclusions:Patients with CHF and RVD were with regard to functional capacity less often responder and showed an unfavorable long-term outcome. Thus, patients with CHF and RVD seem to benefit less frequently from TMVR. K E Y W O R D S chronic heart failure, mitral regurgitation, right ventricular dysfunction, transcatheter mitral valve repair

Prognostic Role of TAPSE to PASP Ratio in Patients Undergoing MitraClip Procedure

“…Altogether, identification of readily available, accurate prognostic predictors remains especially relevant in patients undergoing MitraClip implantation to avoid futility, as patients considered for this intervention often present advanced HF and a high load of comorbidities. Prior studies have recognized numerous indicators of worse outcomes in this population, including reduced bi-ventricular function, enlarged left ventricular (LV) volumes, PH, severe TR and advanced functional class, amongst others [3,[9][10][11][12][13][14][15]31].…”

“…Patients with severe MR considered for a MitraClip procedure often associate pulmonary hypertension (PH) and right ventricular (RV) dysfunction, which are indicators of a worse outcome [12][13][14]. Indeed, many patients are declined a MitraClip procedure due to PH and RV dysfunction, but TMVR may still provide clinical benefit in selected patients and has been associated with a significant reduction in pulmonary pressures and RV reverse remodelling in several studies [14][15][16].…”

Conventional echocardiographic parameters or three-dimensional echocardiography to evaluate right ventricular function in percutaneous edge-to-edge mitral valve repair (PMVR)

“…This observation is in line with our findings, and moreover, we found an improved RV-EF immediately after the PMVR procedure in patients with reduced RV-EF at baseline. It has been shown previously that echocardiography-derived 2D parameters like TAPSE and tissue Doppler derived peak systolic velocity of the lateral tricuspid annulus can identify patients with an increased risk of cardiovascular mortality despite a successful PMVR procedure [[25], [26], [27], [28]]. In our rather small patient collective, 12.5% of the patients with reduced RV-EF below 35% have died, whereas in the group of patients with RV-EF above 35%, 23.81% had died within 6 months after the PMVR procedure.…”

Predictors for procedural success and all-cause mortality in patients undergoing transcatheter mitral valve edge-to-edge repair for mitral regurgitation

“…Obviously, pulmonary hypertension due to left ventricular and atrial dysfunction and RV function are closely linked. Presence of RV dysfunction, as expressed by impaired tricuspid annular plane excursion or RV peak systolic velocity, leads to biventricular failure [ Table 3] [47,[70][71][72] . Importantly, TMVr treatment is capable of improving RV function.…”