Impact of right ventricular-to-pulmonary artery coupling on remodeling and outcome in patients undergoing transcatheter edge-to-edge mitral valve repair
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Published:2023-10-23
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Volume:
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ISSN:1861-0684
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Container-title:Clinical Research in Cardiology
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language:en
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Short-container-title:Clin Res Cardiol
Author:
Koschutnik Matthias,Donà Carolina,Nitsche Christian,Kammerlander Andreas A.,Dannenberg Varius,Brunner Christina,Koschatko Sophia,Mascherbauer Katharina,Heitzinger Gregor,Halavina Kseniya,Spinka Georg,Winter Max-Paul,Hülsmann Martin,Bartko Philipp E.,Hengstenberg Christian,Mascherbauer Julia,Goliasch Georg
Abstract
Abstract
Background
Right ventricular-to-pulmonary artery (RV–PA) coupling has recently been shown to be associated with outcome in valvular heart disease. However, longitudinal data on RV dysfunction and reverse cardiac remodeling in patients following transcatheter edge-to-edge mitral valve repair (M-TEER) are scarce.
Methods
Consecutive patients with primary as well as secondary mitral regurgitation (MR) were prospectively enrolled and had comprehensive echocardiographic and invasive hemodynamic assessment at baseline. Kaplan–Meier estimates and multivariable Cox-regression analyses were performed, using a composite endpoint of heart failure hospitalization and death.
Results
Between April 2018 and January 2021, 156 patients (median 78 y/o, 55% female, EuroSCORE II: 6.9%) underwent M-TEER. On presentation, 64% showed impaired RV–PA coupling defined as tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio < 0.36. Event-free survival rates at 2 years were significantly lower among patients with impaired coupling (57 vs. 82%, p < 0.001), both in patients with primary (64 vs. 91%, p = 0.009) and secondary MR (54 vs. 76%, p = 0.026). On multivariable Cox-regression analyses adjusted for baseline, imaging, hemodynamic, and procedural data, TAPSE/PASP ratio < 0.36 was independently associated with outcome (adj.HR 2.74, 95% CI 1.17–6.43, p = 0.021).
At 1-year follow-up, RV–PA coupling improved (TAPSE: ∆ + 3 mm, PASP: ∆ − 10 mmHg, p for both < 0.001), alongside with a reduction in tricuspid regurgitation (TR) severity (grade ≥ II: 77–54%, p < 0.001).
Conclusions
TAPSE/PASP ratio was associated with outcome in patients undergoing M-TEER for primary as well as secondary MR. RV–PA coupling, alongside with TR severity, improved after M-TEER and might thus provide prognostic information in addition to established markers of poor outcome.
Graphical abstract
Funder
Medical University of Vienna
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,General Medicine
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