Pulmonary capillary wedge pressure (PCWP) as prognostic indicator in patients undergoing transcatheter valve repair (TTVR) of severe tricuspid regurgitation.
Pulmonary capillary wedge pressure
Right heart catheterization
Transcatheter tricuspid valve repair
Tricuspid regurgitation
Tricuspid valve
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
01 Nov 2020
01 Nov 2020
Historique:
received:
12
01
2020
revised:
19
04
2020
accepted:
15
06
2020
pubmed:
1
7
2020
medline:
15
5
2021
entrez:
30
6
2020
Statut:
ppublish
Résumé
TTVR represents a minimal invasive alternative for patients with tricuspid regurgitation (TR). PCWP is a haemodynamic parameter indicating pulmonary hypertension due to left-sided heart failure. We evaluated pulmonary capillary wedge pressure (PCWP) as prognostic outcome parameter in patients undergoing transcatheter tricuspid valve repair (TTVR). A total of 60 patients who underwent right heart catheterization prior to TTVR were included. Patient population was categorized into a low and high PCWP group according to the median PCWP of 16 mmHg. TTVR included transcatheter tricuspid annuloplasty (13 patients) and edge-to-edge repair [37 patients for isolated TR; 10 patients for combined TR and mitral regurgitation]. Kaplan-Meier analysis and log-rank test revealed reduced 6-months event-free survival for patients with high PCWP (>16 mmHg) in comparison to those with low PCWP (≤16 mmHg) (p = 0.009). High PCWP was associated with increased occurrence of the composite endpoint of death and cardiac readmission (HR 4.67, 1.32-16.55). Moreover, adjusted with other predictive variables within the univariate analysis (left ventricular ejection fraction, history of smoking, tricuspid annular plane systolic excursion), PCWP remained an endpoint predictor (HR 1.11, 1.003-1.24). Best predicting value was evaluated for the cut-off >16 mmHg (AUC 0.700, 0.552-0.848). Patients with a high PCWP tended to have less TR recurrence (p = 0,059) and lower NYHA class (p = 0.062) after one month of follow-up. Here we demonstrate that PCWP is a predictive outcome parameter in TTVR patients. Patients with a PCWP ≤16 mmHg had a favourable outcome with lower mortality and morbidity gaining more benefit of TTVR.
Sections du résumé
BACKGROUND
BACKGROUND
TTVR represents a minimal invasive alternative for patients with tricuspid regurgitation (TR). PCWP is a haemodynamic parameter indicating pulmonary hypertension due to left-sided heart failure.
METHODS
METHODS
We evaluated pulmonary capillary wedge pressure (PCWP) as prognostic outcome parameter in patients undergoing transcatheter tricuspid valve repair (TTVR). A total of 60 patients who underwent right heart catheterization prior to TTVR were included. Patient population was categorized into a low and high PCWP group according to the median PCWP of 16 mmHg.
RESULTS
RESULTS
TTVR included transcatheter tricuspid annuloplasty (13 patients) and edge-to-edge repair [37 patients for isolated TR; 10 patients for combined TR and mitral regurgitation]. Kaplan-Meier analysis and log-rank test revealed reduced 6-months event-free survival for patients with high PCWP (>16 mmHg) in comparison to those with low PCWP (≤16 mmHg) (p = 0.009). High PCWP was associated with increased occurrence of the composite endpoint of death and cardiac readmission (HR 4.67, 1.32-16.55). Moreover, adjusted with other predictive variables within the univariate analysis (left ventricular ejection fraction, history of smoking, tricuspid annular plane systolic excursion), PCWP remained an endpoint predictor (HR 1.11, 1.003-1.24). Best predicting value was evaluated for the cut-off >16 mmHg (AUC 0.700, 0.552-0.848). Patients with a high PCWP tended to have less TR recurrence (p = 0,059) and lower NYHA class (p = 0.062) after one month of follow-up.
CONCLUSION
CONCLUSIONS
Here we demonstrate that PCWP is a predictive outcome parameter in TTVR patients. Patients with a PCWP ≤16 mmHg had a favourable outcome with lower mortality and morbidity gaining more benefit of TTVR.
Identifiants
pubmed: 32598993
pii: S0167-5273(20)33409-4
doi: 10.1016/j.ijcard.2020.06.031
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
32-38Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest G.N. received research grants and speaker honoraria from Abbott and Edwards Lifesciences. The other authors have no conflicts of interest to declare.