Right heart catheterization predictors of symptomatic improvement in patients undergoing transcatheter tricuspid valve edge-to-edge repair.
edge-to-edge repair
invasive hemodynamics
transcatheter
tricuspid valve
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:
08 2023
08 2023
Historique:
received:
24
04
2023
accepted:
11
06
2023
medline:
7
8
2023
pubmed:
23
6
2023
entrez:
23
6
2023
Statut:
ppublish
Résumé
Transcatheter tricuspid valve edge-to-edge repair (TTEER) is associated with improvement in outcomes for symptomatic patients with severe tricuspid regurgitation (TR). However, reliable predictors for clinical success are not yet fully defined. This study aims to describe right heart catheterization (RHC) findings in patients referred for TTEER and identify hemodynamic characteristics of patients who experience immediate symptomatic improvement following successful TR intervention. Patients who underwent TTEER and had a separate RHC within the preceding 6 months were included. Hemodynamic tracings from the RHC and TTEER procedures were reviewed and recorded. Clinical success was defined as a successful device implant with at least 1-grade of TR reduction and improvement in NYHA class by 1 or more grades on 30-day echocardiogram and clinical follow-up. Thirteen patients underwent an RHC within 6 months of TTEER procedure (median age 76 years [IQR: 73-80]). All patients were on a stable dose of loop diuretics. Baseline right atrial pressure was severely elevated (mean 19 mmHg [IQR: 9-24 mmHg]) with prominent CV waves. Median pulmonary capillary wedge pressure (PCWP) was 20 mmHg (IQR: 14-22) and 70% of patients had a mean PCWP > 15 mmHg at rest. Median PCWP CV-wave was 34 mmHg (IQR: 23-42). Higher PCWP CV-wave height (40 mmHg [IQR 33-43] versus 18 mmHg [IQR 17-31]) was associated with lower likelihood of clinical success (OR 0.83, 95% CI: 0.35-0.97, p = 0.04). Inclusion of invasive hemodynamics as part of pre-TTEER evaluation may allow for improved TR phenotyping and patient selection. Patients with a large left atrial CV wave on resting RHC were less likely to experience immediate symptomatic improvement despite procedural success with TTEER.
Sections du résumé
BACKGROUND
Transcatheter tricuspid valve edge-to-edge repair (TTEER) is associated with improvement in outcomes for symptomatic patients with severe tricuspid regurgitation (TR). However, reliable predictors for clinical success are not yet fully defined. This study aims to describe right heart catheterization (RHC) findings in patients referred for TTEER and identify hemodynamic characteristics of patients who experience immediate symptomatic improvement following successful TR intervention.
METHODS
Patients who underwent TTEER and had a separate RHC within the preceding 6 months were included. Hemodynamic tracings from the RHC and TTEER procedures were reviewed and recorded. Clinical success was defined as a successful device implant with at least 1-grade of TR reduction and improvement in NYHA class by 1 or more grades on 30-day echocardiogram and clinical follow-up.
RESULTS
Thirteen patients underwent an RHC within 6 months of TTEER procedure (median age 76 years [IQR: 73-80]). All patients were on a stable dose of loop diuretics. Baseline right atrial pressure was severely elevated (mean 19 mmHg [IQR: 9-24 mmHg]) with prominent CV waves. Median pulmonary capillary wedge pressure (PCWP) was 20 mmHg (IQR: 14-22) and 70% of patients had a mean PCWP > 15 mmHg at rest. Median PCWP CV-wave was 34 mmHg (IQR: 23-42). Higher PCWP CV-wave height (40 mmHg [IQR 33-43] versus 18 mmHg [IQR 17-31]) was associated with lower likelihood of clinical success (OR 0.83, 95% CI: 0.35-0.97, p = 0.04).
CONCLUSIONS
Inclusion of invasive hemodynamics as part of pre-TTEER evaluation may allow for improved TR phenotyping and patient selection. Patients with a large left atrial CV wave on resting RHC were less likely to experience immediate symptomatic improvement despite procedural success with TTEER.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
348-358Informations de copyright
© 2023 Wiley Periodicals LLC.
Références
Topilsky Y, Maltais S, Medina Inojosa J, et al. Burden of tricuspid regurgitation in patients diagnosed in the community setting. JACC Cardiovasc Imaging. 2019;12(3):433-442. doi:10.1016/j.jcmg.2018.06.014
Benfari G, Antoine C, Miller WL, et al. Excess mortality associated with functional tricuspid regurgitation complicating heart failure with reduced ejection fraction. Circulation. 2019;140(3):196-206. doi:10.1161/CIRCULATIONAHA.118.038946
Kodali S, Hahn RT, Eleid MF, et al. Feasibility study of the transcatheter valve repair system for severe tricuspid regurgitation. JACC. 2021;77(4):345-356. doi:10.1016/j.jacc.2020.11.047
Lurz P, Orban M, Besler C, et al. Clinical characteristics, diagnosis, and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for transcatheter tricuspid valve repair. Eur Heart J. 2020;41(29):2785-2795. doi:10.1093/eurheartj/ehaa138
Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Am Coll Cardiol. 2017;70(2):252-289. doi:10.1016/j.jacc.2017.03.011
Schlotter F, Dietz MF, Stolz L, et al. Atrial functional tricuspid regurgitation: novel definition and impact on prognosis. Circ Cardiovasc Interv. 2022;15(9):e011958. doi:10.1161/CIRCINTERVENTIONS.122.011958
Wild MG, Löw K, Rosch S, et al. Multicenter experience with the transcatheter leaflet repair system for symptomatic tricuspid regurgitation. JACC Cardiovasc Interv. 2022;15(13):1352-1363. doi:10.1016/j.jcin.2022.05.041
Mehr M, Taramasso M, Besler C, et al. 1-year outcomes after edge-to-edge valve repair for symptomatic tricuspid regurgitation: results from the TriValve Registry. JACC Cardiovasc Interv. 2019;12(15):1451-1461. doi:10.1016/j.jcin.2019.04.019
Nickenig G, Weber M, Lurz P, et al. Transcatheter edge-to-edge repair for reduction of tricuspid regurgitation: 6-month outcomes of the TRILUMINATE single-arm study. Lancet. 2019;394(10213):2002-2011. doi:10.1016/S0140-6736(19)32600-5
Schlotter F, Orban M, Rommel KP, et al. Aetiology-based clinical scenarios predict outcomes of transcatheter edge-to-edge tricuspid valve repair of functional tricuspid regurgitation. Eur J Heart Fail. 2019;21(9):1117-1125. doi:10.1002/ejhf.1547
Stocker TJ, Hertell H, Orban M, et al. Cardiopulmonary hemodynamic profile predicts mortality after transcatheter tricuspid valve repair in chronic heart failure. JACC Cardiovascr Interv. 2021;14(1):29-38. doi:10.1016/j.jcin.2020.09.033
Sugiura A, Kavsur R, Spieker M, et al. Impact of right ventricular-pulmonary arterial coupling on clinical outcomes of tricuspid regurgitation. EuroIntervention. 2022;18:852-861. doi:10.4244/EIJ-D-22-00045
Hahn RT. State-of-the-art review of echocardiographic imaging in the evaluation and treatment of functional tricuspid regurgitation. Circ Cardiovasc Imaging. 2016;9(12):e005332. doi:10.1161/CIRCIMAGING.116.005332
Hahn RT, Zamorano JL. The need for a new tricuspid regurgitation grading scheme. Eur Heart J Cardiovasc Imaging. 2017;18(12):1342-1343. doi:10.1093/ehjci/jex139
El-Tallawi KC, Messika-Zeitoun D, Zoghbi WA. Assessment of the severity of native mitral valve regurgitation. Prog Cardiovasc Dis. 2017;60(3):322-333. doi:10.1016/j.pcad.2017.11.005
Brener MI, Lurz P, Hausleiter J, et al. Right ventricular-pulmonary arterial coupling and afterload reserve in patients undergoing transcatheter tricuspid valve repair. J Am Coll Cardiol. 2022;79(5):448-461. doi:10.1016/j.jacc.2021.11.031
Andersen MJ, Nishimura RA, Borlaug BA. The hemodynamic basis of exercise intolerance in tricuspid regurgitation. Circ Heart Fail. 2014;7(6):911-917. doi:10.1161/CIRCHEARTFAILURE.114.001575
Nishimura RA, Carabello BA. Hemodynamics in the cardiac catheterization laboratory of the 21st century. Circulation. 2012;125(17):2138-2150. doi:10.1161/CIRCULATIONAHA.111.060319
Kochav SM, Flores RJ, Truby LK, Topkara VK. Prognostic impact of Pulmonary Artery Pulsatility Index (PAPi) in patients with advanced heart failure: insights from the ESCAPE trial. J Card Failure. 2018;24(7):453-459. doi:10.1016/j.cardfail.2018.03.008
Mahowald MK, Nishimura RA, Pislaru SV, et al. Reduction in right atrial pressures is associated with hemodynamic improvements after transcatheter edge-to-edge repair of the tricuspid valve. Circ Cardiovasc Interv. 2021;14(12):e010557. doi:10.1161/CIRCINTERVENTIONS.121.010557
Lurz P, Stephan von Bardeleben R, Weber M, et al. Transcatheter edge-to-edge repair for treatment of tricuspid regurgitation. J Am Coll Cardiol. 2021;77(3):229-239. doi:10.1016/j.jacc.2020.11.038
Tua L, Mandurino-Mirizzi A, Colombo C, et al. The impact of transcatheter edge-to-edge repair on right ventricle-pulmonary artery coupling in patients with functional mitral regurgitation. Eur J Clin Invest. 2022;53:e13869. doi:10.1111/eci.13869
Borlaug BA, Reddy YNV. The role of the pericardium in heart failure. JACC Heart Fail. 2019;7(7):574-585. doi:10.1016/j.jchf.2019.03.021
Reddy YNV, Obokata M, Verbrugge FH, Lin G, Borlaug BA. Atrial dysfunction in patients with heart failure with preserved ejection fraction and atrial fibrillation. J Am Coll Cardiol. 2020;76(9):1051-1064. doi:10.1016/j.jacc.2020.07.009
Obokata M, Reddy YNV, Melenovsky V, Pislaru S, Borlaug BA. Deterioration in right ventricular structure and function over time in patients with heart failure and preserved ejection fraction. Eur Heart J. 2019;40(8):689-697. doi:10.1093/eurheartj/ehy809
Harada T, Obokata M, Omote K, et al. Functional tricuspid regurgitation and right atrial remodeling in heart failure with preserved ejection fraction. Am J Cardiol. 2022;162:129-135. doi:10.1016/j.amjcard.2021.09.021
Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461. doi:10.1056/NEJMoa2107038
Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098. doi:10.1056/NEJMoa2206286
Pfeffer MA, Claggett B, Assmann SF, et al. Regional variation in patients and outcomes in the treatment of preserved cardiac function heart failure with an aldosterone antagonist (TOPCAT) trial. Circulation. 2015;131(1):34-42. doi:10.1161/CIRCULATIONAHA.114.013255