Right ventricular dysfunction predicts outcome after transcatheter mitral valve repair for primary mitral valve regurgitation
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Right ventricular dysfunction predicts outcome after transcatheter mitral valve repair for primary mitral valve regurgitation. / Doldi, Philipp M; Stolz, Lukas; Kalbacher, Daniel; Köll, Benedikt; Geyer, Martin; Ludwig, Sebastian; Orban, Mathias; Braun, Daniel; Weckbach, Ludwig T; Stocker, Thomas J; Näbauer, Michael; Higuchi, Satoshi; Ruf, Tobias; Da Rocha E Silva, Jaqueline; Wild, Mirjam; Tence, Noemie; Unterhuber, Matthias; Schofer, Niklas; Petrescu, Aniela; Thiele, Holger; Lurz, Philipp; Lubos, Edith; von Bardeleben, Stephan; Karam, Nicole; Samim, Daryoush; Paradis, Jean-Michel; Iliadis, Christos; Xhepa, Erion; Hagl, Christian; Massberg, Steffen; Hausleiter, Jörg; EuroSMR and PRIME-MR Investigators.
In: EUR J HEART FAIL, Vol. 24, No. 11, 11.2022, p. 2162-2171.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Right ventricular dysfunction predicts outcome after transcatheter mitral valve repair for primary mitral valve regurgitation
AU - Doldi, Philipp M
AU - Stolz, Lukas
AU - Kalbacher, Daniel
AU - Köll, Benedikt
AU - Geyer, Martin
AU - Ludwig, Sebastian
AU - Orban, Mathias
AU - Braun, Daniel
AU - Weckbach, Ludwig T
AU - Stocker, Thomas J
AU - Näbauer, Michael
AU - Higuchi, Satoshi
AU - Ruf, Tobias
AU - Da Rocha E Silva, Jaqueline
AU - Wild, Mirjam
AU - Tence, Noemie
AU - Unterhuber, Matthias
AU - Schofer, Niklas
AU - Petrescu, Aniela
AU - Thiele, Holger
AU - Lurz, Philipp
AU - Lubos, Edith
AU - von Bardeleben, Stephan
AU - Karam, Nicole
AU - Samim, Daryoush
AU - Paradis, Jean-Michel
AU - Iliadis, Christos
AU - Xhepa, Erion
AU - Hagl, Christian
AU - Massberg, Steffen
AU - Hausleiter, Jörg
AU - EuroSMR and PRIME-MR Investigators
N1 - © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2022/11
Y1 - 2022/11
N2 - AIMS: Right ventricular dysfunction (RVD), as expressed by right ventricular to pulmonary artery coupling, has recently been identified as a strong outcome predictor in patients undergoing mitral valve edge-to-edge repair (M-TEER) for secondary mitral regurgitation (MR). The aim of this study was to define RVD in patients undergoing M-TEER for primary MR (PMR) and to evaluate its impact on procedural MR reduction, symptomatic development and 2-year all-cause mortality.METHODS AND RESULTS: This multicentre study included patients undergoing M-TEER for symptomatic PMR at nine international centres. The study cohort was divided into a derivation (DC) and validation cohort (VC) for calculation and validation of the best discriminatory value for RVD. A total of 648 PMR patients were included in the study. DC and VC were comparable regarding procedural success and outcomes at follow-up. Sensitivity analysis identified RVD as an independent predictor for 2-year mortality in the DC (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.47-3.81, p < 0.001), which was confirmed in the VC (HR 2.06, 95% CI 1.36-3.13, p < 0.001). Procedural success (MR ≤2+) and symptomatic improvement at follow-up (New York Heart Association [NYHA] class ≤II) were lower in PMR patients with RVD (MR ≤2+: 82% vs. 93%, p = 0.002; NYHA class ≤II: 57.3% vs. 66.5%, p = 0.09 for with vs. without RVD). In all PMR patients, the presence of RVD significantly impaired 2-year survival after M-TEER (HR 2.23, 95% CI 1.63-3.05, p < 0.001).CONCLUSIONS: Mitral valve edge-to-edge repair is an effective treatment option for PMR patients. The presence of RVD is associated with less MR reduction, less symptomatic improvement and increased 2-year mortality. Accordingly, RVD might be included into pre-procedural prognostic considerations.
AB - AIMS: Right ventricular dysfunction (RVD), as expressed by right ventricular to pulmonary artery coupling, has recently been identified as a strong outcome predictor in patients undergoing mitral valve edge-to-edge repair (M-TEER) for secondary mitral regurgitation (MR). The aim of this study was to define RVD in patients undergoing M-TEER for primary MR (PMR) and to evaluate its impact on procedural MR reduction, symptomatic development and 2-year all-cause mortality.METHODS AND RESULTS: This multicentre study included patients undergoing M-TEER for symptomatic PMR at nine international centres. The study cohort was divided into a derivation (DC) and validation cohort (VC) for calculation and validation of the best discriminatory value for RVD. A total of 648 PMR patients were included in the study. DC and VC were comparable regarding procedural success and outcomes at follow-up. Sensitivity analysis identified RVD as an independent predictor for 2-year mortality in the DC (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.47-3.81, p < 0.001), which was confirmed in the VC (HR 2.06, 95% CI 1.36-3.13, p < 0.001). Procedural success (MR ≤2+) and symptomatic improvement at follow-up (New York Heart Association [NYHA] class ≤II) were lower in PMR patients with RVD (MR ≤2+: 82% vs. 93%, p = 0.002; NYHA class ≤II: 57.3% vs. 66.5%, p = 0.09 for with vs. without RVD). In all PMR patients, the presence of RVD significantly impaired 2-year survival after M-TEER (HR 2.23, 95% CI 1.63-3.05, p < 0.001).CONCLUSIONS: Mitral valve edge-to-edge repair is an effective treatment option for PMR patients. The presence of RVD is associated with less MR reduction, less symptomatic improvement and increased 2-year mortality. Accordingly, RVD might be included into pre-procedural prognostic considerations.
KW - Humans
KW - Mitral Valve Insufficiency/surgery
KW - Ventricular Dysfunction, Right
KW - Mitral Valve/surgery
KW - Heart Failure
U2 - 10.1002/ejhf.2661
DO - 10.1002/ejhf.2661
M3 - SCORING: Journal article
C2 - 36054557
VL - 24
SP - 2162
EP - 2171
JO - EUR J HEART FAIL
JF - EUR J HEART FAIL
SN - 1388-9842
IS - 11
ER -
