Right atrial structural remodeling predict worse outcomes in transcatheter mitral valve repair.
Cardiac Remodeling
Echocardiography
LAVI
Mitraclip
Mitral Regurgitation
RAVI
RAVI/LAVI Ratio
Transcatheter Mitral Valve Repair
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
revised:
12
03
2022
received:
26
01
2021
accepted:
08
10
2022
pubmed:
3
11
2022
medline:
21
1
2023
entrez:
2
11
2022
Statut:
ppublish
Résumé
In the current study, we assess the predictive role of right and left atrial volume indices (RAVI and LAVI) as well as the ratio of RAVI/LAVI (RLR) on mortality following transcatheter mitral valve repair (TMVr). Transthoracic echocardiograms of 158 patients who underwent TMVr at a single academic medical center from 2011 to 2018 were reviewed retrospectively. RAVI and LAVI were calculated using Simpson's method. Patients were stratified based on etiology of mitral regurgitation (MR). Cox proportional-hazard regression was created utilizing MR type, STS-score, and RLR to assess the independent association of RLR with survival. Kaplan-Meier analysis was used to analyze the association between RAVI and LAVI with all-cause mortality. Hemodynamic values from preprocedural right heart catheterization were also compared between RLR groups. Among 123 patients included (median age 81.3 years; 52.5% female) there were 50 deaths during median follow-up of 3.0 years. Patients with a high RAVI and low LAVI had significantly higher all-cause mortality while patients with high LAVI and low RAVI had significantly improved all-cause mortality compared to other groups (p = 0.0032). RLR was significantly associated with mortality in patients with both functional and degenerative MR (p = 0.0038). Finally, Cox proportion-hazard modeling demonstrated that an elevated RLR above the median value was an independent predictor of all-cause mortality [HR = 2.304; 95% CI = 1.26-4.21, p = 0.006] when MR type and STS score were accounted for. Patients with a high RAVI and low LAVI had significantly increased mortality than other groups following TMVr suggesting RA remodeling may predict worse outcomes following the procedure. Concordantly, RLR was predictive of mortality independent of MR type and preprocedural STS-score. These indices may provide additional risk stratification in patients undergoing evaluation for TMVr.
Sections du résumé
BACKGROUND
In the current study, we assess the predictive role of right and left atrial volume indices (RAVI and LAVI) as well as the ratio of RAVI/LAVI (RLR) on mortality following transcatheter mitral valve repair (TMVr).
METHODS
Transthoracic echocardiograms of 158 patients who underwent TMVr at a single academic medical center from 2011 to 2018 were reviewed retrospectively. RAVI and LAVI were calculated using Simpson's method. Patients were stratified based on etiology of mitral regurgitation (MR). Cox proportional-hazard regression was created utilizing MR type, STS-score, and RLR to assess the independent association of RLR with survival. Kaplan-Meier analysis was used to analyze the association between RAVI and LAVI with all-cause mortality. Hemodynamic values from preprocedural right heart catheterization were also compared between RLR groups.
RESULTS
Among 123 patients included (median age 81.3 years; 52.5% female) there were 50 deaths during median follow-up of 3.0 years. Patients with a high RAVI and low LAVI had significantly higher all-cause mortality while patients with high LAVI and low RAVI had significantly improved all-cause mortality compared to other groups (p = 0.0032). RLR was significantly associated with mortality in patients with both functional and degenerative MR (p = 0.0038). Finally, Cox proportion-hazard modeling demonstrated that an elevated RLR above the median value was an independent predictor of all-cause mortality [HR = 2.304; 95% CI = 1.26-4.21, p = 0.006] when MR type and STS score were accounted for.
CONCLUSION
Patients with a high RAVI and low LAVI had significantly increased mortality than other groups following TMVr suggesting RA remodeling may predict worse outcomes following the procedure. Concordantly, RLR was predictive of mortality independent of MR type and preprocedural STS-score. These indices may provide additional risk stratification in patients undergoing evaluation for TMVr.
Identifiants
pubmed: 36321593
doi: 10.1002/ccd.30471
pmc: PMC10092558
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
217-224Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
Références
Curr Treat Options Cardiovasc Med. 2019 Sep 10;21(10):60
pubmed: 31506851
Resuscitation. 2022 Jan;170:306-313
pubmed: 34695443
N Engl J Med. 2018 Dec 13;379(24):2307-2318
pubmed: 30280640
Catheter Cardiovasc Interv. 2023 Jan;101(1):217-224
pubmed: 36321593
J Heart Lung Transplant. 2016 Jun;35(6):760-7
pubmed: 26856665
Circulation. 2006 Oct 24;114(17):1883-91
pubmed: 17060398
Cardiovasc Res. 2017 Oct 1;113(12):1474-1485
pubmed: 28957537
J Echocardiogr. 2022 Mar;20(1):42-50
pubmed: 34623621
Am J Cardiol. 2018 Oct 1;122(7):1204-1209
pubmed: 30097169
Am J Cardiol. 2015 Jan 1;115(1):107-12
pubmed: 25456878
JAMA Cardiol. 2020 Jan 1;5(1):47-56
pubmed: 31746963
JACC Cardiovasc Imaging. 2009 May;2(5):527-34
pubmed: 19442936
Int J Cardiovasc Imaging. 2020 May;36(5):811-819
pubmed: 31933101
ESC Heart Fail. 2018 Oct;5(5):780-787
pubmed: 29893475
J Am Heart Assoc. 2019 Sep 3;8(17):e013332
pubmed: 31441371
J Am Coll Cardiol. 2019 Dec 17;74(24):2969-2979
pubmed: 31574303
Echocardiography. 2016 Oct;33(10):1504-1511
pubmed: 27350336
J Atr Fibrillation. 2013 Dec 31;6(4):986
pubmed: 28496919
Ochsner J. 2009 Winter;9(4):191-6
pubmed: 21603443
J Am Coll Cardiol. 2015 Jul 21;66(3):278-307
pubmed: 26184622
Resuscitation. 2022 Jan;170:314-315
pubmed: 34838944
J Thorac Dis. 2020 Apr;12(4):1728-1739
pubmed: 32395315
Curr Heart Fail Rep. 2018 Apr;15(2):94-105
pubmed: 29468529
J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14
pubmed: 25559473
Echocardiography. 2018 Nov;35(11):1729-1735
pubmed: 30315607
Lancet. 2006 Sep 16;368(9540):1005-11
pubmed: 16980116
J Ultrasound Med. 2016 Jan;35(1):49-61
pubmed: 26614791