Prognostic significance of right ventricular free wall longitudinal strain in patients undergoing percutaneous edge-to-edge mitral valve repair for functional mitral regurgitation

Abstract

Abstract Purpose To evaluate if right ventricular (RV) dysfunction assessed by RV free wall longitudinal strain (RVFWLS) is associated with poor clinical outcome of patients with functional mitral regurgitation (FMR) undergoing transcatheter edge-to-edge repair (TEER), and to investigate the potential incremental value of RVFWLS for prognostic stratification over tricuspid annular plane systolic excursion (TAPSE). Methods This study included consecutive FMR patients undergoing successful TEER at our Institution. All patients underwent systematic echocardiographic assessment of RV function with both RVFWLS and TAPSE. Values of TAPSE < 17 mm and of RVFWLS >-20% were considered abnormal. The primary outcome was the composite of hospitalization for worsening heart failure and all-cause mortality. Results The study included 102 patients. At long-term follow-up (median 22 months), the primary outcome was reported in 60 (58.8%) patients. Patients with RV dysfunction according to both TAPSE and RVFWLS cut-off values showed a lower survival free from the primary outcome compared to patients with preserved RV function. After weighting for clinical confounders and multivariable adjustment for the main echocardiographic parameters, RVFWLS resulted independently associated with the primary outcome; conversely, TAPSE was not significantly associated with the primary outcome. Among patients with preserved RV function according to TAPSE, impaired RVFWLS identified patients with the lower survival free from the primary outcome compared to those with preserved RVFWLS (Log-Rank = 0.008). Conclusions In patient with FMR undergoing TEER, RV dysfunction assessed by RVFWLS was independently associated with long-term outcome and showed incremental value for prognostic stratification of patients with normal TAPSE.