Right ventricular dysfunction predicts outcome after transcatheter mitral valve repair for primary mitral valve regurgitation.
Edge-to-edge repair
Primary mitral valve regurgitation
Right ventricular dysfunction
Transcatheter mitral valve repair
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
revised:
09
08
2022
received:
18
07
2022
accepted:
20
08
2022
pubmed:
3
9
2022
medline:
15
12
2022
entrez:
2
9
2022
Statut:
ppublish
Résumé
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. 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). 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.
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2162-2171Investigateurs
Roman Pfister
(R)
Philipp von Stein
(P)
Teresa Trenkwalder
(T)
Hector Alfonso Alvarez Covarrubias
(HA)
Sandra Hadjadj
(S)
Dounia Rouabhia
(D)
Nicolas Brugger
(N)
Joanna Bartkowiak
(J)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Références
Feldman T, Fernandes E, Levisay JP. Transcatheter mitral valve repair/replacement for primary mitral regurgitation. Ann Cardiothorac Surg. 2018;7:755-63.
Lim DS, Reynolds MR, Feldman T, Kar S, Herrmann HC, Wang A, et al. Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair. J Am Coll Cardiol. 2014;64:182-92.
Sultan I, Cardounel A, Abdelkarim I, Kilic A, Althouse AD, Sharbaugh MS, et al. Right ventricle to pulmonary artery coupling in patients undergoing transcatheter aortic valve implantation. Heart. 2019;105:117-21.
Hsu S, Simpson CE, Houston BA, Wand A, Sato T, Kolb TM, et al. Multi-beat right ventricular-arterial coupling predicts clinical worsening in pulmonary arterial hypertension. J Am Heart Assoc. 2020;9:e016031.
Melenovsky V, Hwang SJ, Lin G, Redfield MM, Borlaug BA. Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J. 2014;35:3452-62.
Asami M, Stortecky S, Praz F, Lanz J, Räber L, Franzone A, et al. Prognostic value of right ventricular dysfunction on clinical outcomes after transcatheter aortic valve replacement. JACC Cardiovasc Imaging. 2019;12:577-87.
Champion HC, Michelakis ED, Hassoun PM. Comprehensive invasive and noninvasive approach to the right ventricle-pulmonary circulation unit: state of the art and clinical and research implications. Circulation. 2009;120:992-1007.
Cahill T, Pibarot P, Babaliaros V, Blanke P, Clavel MA, Douglas P, et al. Impact of right ventricle-pulmonary artery coupling on clinical outcomes after transcatheter and surgical aortic valve replacement: an analysis of the PARTNER 3 trial. J Am Coll Cardiol. 2021;78(Suppl):B17 (abstr).
Karam N, Stolz L, Orban M, Deseive S, Praz F, Kalbacher D, et al. Impact of right ventricular dysfunction on outcomes after transcatheter edge-to-edge repair for secondary mitral regurgitation. JACC Cardiovasc Imaging. 2021;14:768-78.
Brener MI, Grayburn P, Lindenfeld J, Burkhoff D, Liu M, Zhou Z, et al. Right ventricular-pulmonary arterial coupling in patients with HF secondary MR: analysis from the COAPT trial. JACC Cardiovasc Interv. 2021;14:2231-42.
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al.; ESC/EACTS Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022;43:561-632.
Feldman T, Kar S, Rinaldi M, Fail P, Hermiller J, Smalling R, et al.; EVEREST Investigators. Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. J Am Coll Cardiol. 2009;54:686-94.
Shephard DA. The 1975 Declaration of Helsinki and consent. Can Med Assoc J. 1976;115:1191-2.
Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, et al.; European Association of Echocardiography. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010;11:307-32.
Aloia E, Cameli M, D'Ascenzi F, Sciaccaluga C, Mondillo S. TAPSE: an old but useful tool in different diseases. Int J Cardiol. 2016;225:177-83.
Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23:685-713.
Kaul S, Tei C, Hopkins JM, Shah PM. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J. 1984;107:526-31.
Sunagawa K, Maughan WL, Burkhoff D, Sagawa K. Left ventricular interaction with arterial load studied in isolated canine ventricle. Am J Physiol. 1983;245:H773-80.
Guazzi M, Bandera F, Pelissero G, Castelvecchio S, Menicanti L, Ghio S, et al. Tricuspid annular plane systolic excursion and pulmonary arterial systolic pressure relationship in heart failure: an index of right ventricular contractile function and prognosis. Am J Physiol Heart Circ Physiol. 2013;305:H1373-81.
Guazzi M, Dixon D, Labate V, Beussink-Nelson L, Bandera F, Cuttica MJ, et al. RV contractile function and its coupling to pulmonary circulation in heart failure with preserved ejection fraction: stratification of clinical phenotypes and outcomes. JACC Cardiovasc Imaging. 2017;10:1211-21.
Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, et al.; COAPT Investigators. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018;379:2307-18.
Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N, et al.; MITRA-FR Investigators. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med. 2018;379:2297-306.
Lesevic H, Karl M, Braun D, Barthel P, Orban M, Pache J, et al. Long-term outcomes after MitraClip implantation according to the presence or absence of EVEREST inclusion criteria. Am J Cardiol. 2017;119:1255-61.
Feldman T, Kar S, Elmariah S, Smart SC, Trento A, Siegel RJ, et al.; EVEREST II Investigators. Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5-year results of EVEREST II. J Am Coll Cardiol. 2015;66:2844-54.
Mauri L, Foster E, Glower DD, Apruzzese P, Massaro JM, Herrmann HC, et al.; EVEREST II Investigators. 4-year results of a randomized controlled trial of percutaneous repair versus surgery for mitral regurgitation. J Am Coll Cardiol. 2013;62:317-28.
Iliadis C, Lee S, Kuhr K, Metze C, Matzik AS, Michels G, et al. Functional status and quality of life after transcatheter mitral valve repair: a prospective cohort study and systematic review. Clin Res Cardiol. 2017;106:1005-17.
Arnold SV, Li Z, Vemulapalli S, Baron SJ, Mack MJ, Kosinski AS, et al. Association of transcatheter mitral valve repair with quality of life outcomes at 30 days and 1 year: analysis of the Transcatheter Valve Therapy Registry. JAMA Cardiol. 2018;3:1151-9.
ClinicalTrials.gov. Transcatheter Mitral Valve Repair for the Treatment of Mitral Valve Regurgitation in Heart Failure (EVOLVE-MR). https://ClinicalTrials.gov/show/NCT03891823.
ClinicalTrials.gov. Percutaneous or Surgical Mitral Valve Repair (PRIMARY). https://ClinicalTrials.gov/show/NCT05051033.
ClinicalTrials.gov. MitraClip REPAIR MR Study. https://ClinicalTrials.gov/show/NCT04198870.
Popolo Rubbio A, Testa L, Granata G, Salvatore T, De Marco F, Casenghi M, et al. Prognostic significance of right ventricle to pulmonary artery coupling in patients with mitral regurgitation treated with the MitraClip system. Catheter Cardiovasc Interv. 2022;99:1277-86.
Trejo-Velasco B, Estevez-Loureiro R, Carrasco-Chinchilla F, Fernández-Vázquez F, Arzamendi D, Pan M, et al. Prognostic role of TAPSE to PASP ratio in patients undergoing MitraClip procedure. J Clin Med. 2021;10:1006.
Ong G, Fam NP. Combined transcatheter mitral and tricuspid edge-to-edge repair: expanding the horizons of interventional heart failure. Curr Opin Cardiol. 2021;36:148-53.