Impact of Right Ventricular Dysfunction on Outcomes After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation
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Impact of Right Ventricular Dysfunction on Outcomes After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation. / Karam, Nicole; Stolz, Lukas; Orban, Mathias; Deseive, Simon; Praz, Fabien; Kalbacher, Daniel; Westermann, Dirk; Braun, Daniel; Näbauer, Michael; Neuss, Michael; Butter, Christian; Kassar, Mohammad; Petrescu, Aniela; Pfister, Roman; Iliadis, Christos; Unterhuber, Matthias; Park, Sang-Don; Thiele, Holger; Baldus, Stephan; Stephan von Bardeleben, Ralph; Blankenberg, Stefan; Massberg, Steffen; Windecker, Stephan; Lurz, Philipp; Hausleiter, Jörg.
in: JACC-CARDIOVASC IMAG, Jahrgang 14, Nr. 4, 04.2021, S. 768-778.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Impact of Right Ventricular Dysfunction on Outcomes After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation
AU - Karam, Nicole
AU - Stolz, Lukas
AU - Orban, Mathias
AU - Deseive, Simon
AU - Praz, Fabien
AU - Kalbacher, Daniel
AU - Westermann, Dirk
AU - Braun, Daniel
AU - Näbauer, Michael
AU - Neuss, Michael
AU - Butter, Christian
AU - Kassar, Mohammad
AU - Petrescu, Aniela
AU - Pfister, Roman
AU - Iliadis, Christos
AU - Unterhuber, Matthias
AU - Park, Sang-Don
AU - Thiele, Holger
AU - Baldus, Stephan
AU - Stephan von Bardeleben, Ralph
AU - Blankenberg, Stefan
AU - Massberg, Steffen
AU - Windecker, Stephan
AU - Lurz, Philipp
AU - Hausleiter, Jörg
N1 - Copyright © 2021. Published by Elsevier Inc.
PY - 2021/4
Y1 - 2021/4
N2 - OBJECTIVES: This study sought to assess the impact of right ventricular dysfunction (RVD) as defined by impaired right ventricular-to-pulmonary artery (RV-PA) coupling, on survival after edge-to-edge transcatheter mitral valve repair (TMVR) for severe secondary mitral regurgitation (SMR).BACKGROUND: Conflicting data exist regarding the benefit of TMVR in severe SMR. A possible explanation could be differences in RVD.METHODS: Using data from the EuroSMR (European Registry on Outcomes in Secondary Mitral Regurgitation) registry, this study compared the characteristics and outcomes of SMR patients undergoing TMVR, according to their RV-PA coupling, assessed by tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure (TAPSE/sPAP) ratio.RESULTS: Overall, 817 patients with severe SMR and available RV-PA coupling assessment underwent TMVR in the participating centers. RVD was present in 211 patients (25.8% with a TAPSE/sPAP ratio <0.274 mm/mm Hg). Although all patients demonstrated significant improvement in their New York Heart Association (NYHA) functional class, there was a trend toward a lower rate of NYHA functional class I or II among patients with RVD (56.5% vs. 65.5%, respectively; p = 0.086) after TMVR. Survival rates at 1 and 2 years were lower among patients with RVD (70.2% vs. 84.0%, respectively; p < 0.001; and 53.4% vs. 73.1%, respectively; p < 0.001). On multivariate analysis, a reduced TAPSE/sPAP ratio was a strong predictor of mortality (odds ratio: 1.62; 95% confidence interval: 1.14 to 2.31; p = 0.007).CONCLUSIONS: RVD, as shown by impairment of RV-PA coupling, is a major predictor of adverse outcome in patients undergoing TMVR for severe SMR. The often neglected functional and anatomic RV parameters should be systematically assessed when planning TMVR procedures for patients with severe SMR.
AB - OBJECTIVES: This study sought to assess the impact of right ventricular dysfunction (RVD) as defined by impaired right ventricular-to-pulmonary artery (RV-PA) coupling, on survival after edge-to-edge transcatheter mitral valve repair (TMVR) for severe secondary mitral regurgitation (SMR).BACKGROUND: Conflicting data exist regarding the benefit of TMVR in severe SMR. A possible explanation could be differences in RVD.METHODS: Using data from the EuroSMR (European Registry on Outcomes in Secondary Mitral Regurgitation) registry, this study compared the characteristics and outcomes of SMR patients undergoing TMVR, according to their RV-PA coupling, assessed by tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure (TAPSE/sPAP) ratio.RESULTS: Overall, 817 patients with severe SMR and available RV-PA coupling assessment underwent TMVR in the participating centers. RVD was present in 211 patients (25.8% with a TAPSE/sPAP ratio <0.274 mm/mm Hg). Although all patients demonstrated significant improvement in their New York Heart Association (NYHA) functional class, there was a trend toward a lower rate of NYHA functional class I or II among patients with RVD (56.5% vs. 65.5%, respectively; p = 0.086) after TMVR. Survival rates at 1 and 2 years were lower among patients with RVD (70.2% vs. 84.0%, respectively; p < 0.001; and 53.4% vs. 73.1%, respectively; p < 0.001). On multivariate analysis, a reduced TAPSE/sPAP ratio was a strong predictor of mortality (odds ratio: 1.62; 95% confidence interval: 1.14 to 2.31; p = 0.007).CONCLUSIONS: RVD, as shown by impairment of RV-PA coupling, is a major predictor of adverse outcome in patients undergoing TMVR for severe SMR. The often neglected functional and anatomic RV parameters should be systematically assessed when planning TMVR procedures for patients with severe SMR.
KW - Cardiac Surgical Procedures
KW - Humans
KW - Mitral Valve Insufficiency/diagnostic imaging
KW - Predictive Value of Tests
KW - Treatment Outcome
KW - Ventricular Dysfunction, Right/diagnostic imaging
U2 - 10.1016/j.jcmg.2020.12.015
DO - 10.1016/j.jcmg.2020.12.015
M3 - SCORING: Journal article
C2 - 33582067
VL - 14
SP - 768
EP - 778
JO - JACC-CARDIOVASC IMAG
JF - JACC-CARDIOVASC IMAG
SN - 1936-878X
IS - 4
ER -
