Nicole Karam1, Lukas Stolz2, Mathias Orban3, Simon Deseive2, Fabien Praz4, Daniel Kalbacher5, Dirk Westermann5, Daniel Braun2, Michael Näbauer2, Michael Neuss6, Christian Butter6, Mohammad Kassar4, Aniela Petrescu7, Roman Pfister8, Christos Iliadis8, Matthias Unterhuber9, Sang-Don Park2, Holger Thiele9, Stephan Baldus8, Ralph Stephan von Bardeleben7, Stefan Blankenberg5, Steffen Massberg3, Stephan Windecker4, Philipp Lurz9, Jörg Hausleiter10. 1. Department of Cardiology, European Hospital Georges Pompidou and Paris Cardiovascular Research Center (INSERM U970), Paris, France. 2. Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany. 3. Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site, German Center for Cardiovascular Disease, Munich, Germany. 4. Universitätsklinik für Kardiologie, Inselspital Bern, Switzerland. 5. Klinik für Kardiologie, Universitäres Herz und Gefäßzentrum Hamburg, Hamburg, Germany. 6. Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany. 7. Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany. 8. Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany. 9. Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany. 10. Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site, German Center for Cardiovascular Disease, Munich, Germany. Electronic address: joerg.hausleiter@med.uni-muenchen.de.
Abstract
OBJECTIVES: This study sought to assess the impact of right ventricular dysfunction (RVD) as defined by impaired right ventricular-to-pulmonary artery (RV-PA) coupling, on survival after edge-to-edge transcatheter mitral valve repair (TMVR) for severe secondary mitral regurgitation (SMR). BACKGROUND: Conflicting data exist regarding the benefit of TMVR in severe SMR. A possible explanation could be differences in RVD. METHODS: Using data from the EuroSMR (European Registry on Outcomes in Secondary Mitral Regurgitation) registry, this study compared the characteristics and outcomes of SMR patients undergoing TMVR, according to their RV-PA coupling, assessed by tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure (TAPSE/sPAP) ratio. RESULTS: Overall, 817 patients with severe SMR and available RV-PA coupling assessment underwent TMVR in the participating centers. RVD was present in 211 patients (25.8% with a TAPSE/sPAP ratio <0.274 mm/mm Hg). Although all patients demonstrated significant improvement in their New York Heart Association (NYHA) functional class, there was a trend toward a lower rate of NYHA functional class I or II among patients with RVD (56.5% vs. 65.5%, respectively; p = 0.086) after TMVR. Survival rates at 1 and 2 years were lower among patients with RVD (70.2% vs. 84.0%, respectively; p < 0.001; and 53.4% vs. 73.1%, respectively; p < 0.001). On multivariate analysis, a reduced TAPSE/sPAP ratio was a strong predictor of mortality (odds ratio: 1.62; 95% confidence interval: 1.14 to 2.31; p = 0.007). CONCLUSIONS: RVD, as shown by impairment of RV-PA coupling, is a major predictor of adverse outcome in patients undergoing TMVR for severe SMR. The often neglected functional and anatomic RV parameters should be systematically assessed when planning TMVR procedures for patients with severe SMR.
OBJECTIVES: This study sought to assess the impact of right ventricular dysfunction (RVD) as defined by impaired right ventricular-to-pulmonary artery (RV-PA) coupling, on survival after edge-to-edge transcatheter mitral valve repair (TMVR) for severe secondary mitral regurgitation (SMR). BACKGROUND: Conflicting data exist regarding the benefit of TMVR in severe SMR. A possible explanation could be differences in RVD. METHODS: Using data from the EuroSMR (European Registry on Outcomes in Secondary Mitral Regurgitation) registry, this study compared the characteristics and outcomes of SMR patients undergoing TMVR, according to their RV-PA coupling, assessed by tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure (TAPSE/sPAP) ratio. RESULTS: Overall, 817 patients with severe SMR and available RV-PA coupling assessment underwent TMVR in the participating centers. RVD was present in 211 patients (25.8% with a TAPSE/sPAP ratio <0.274 mm/mm Hg). Although all patients demonstrated significant improvement in their New York Heart Association (NYHA) functional class, there was a trend toward a lower rate of NYHA functional class I or II among patients with RVD (56.5% vs. 65.5%, respectively; p = 0.086) after TMVR. Survival rates at 1 and 2 years were lower among patients with RVD (70.2% vs. 84.0%, respectively; p < 0.001; and 53.4% vs. 73.1%, respectively; p < 0.001). On multivariate analysis, a reduced TAPSE/sPAP ratio was a strong predictor of mortality (odds ratio: 1.62; 95% confidence interval: 1.14 to 2.31; p = 0.007). CONCLUSIONS: RVD, as shown by impairment of RV-PA coupling, is a major predictor of adverse outcome in patients undergoing TMVR for severe SMR. The often neglected functional and anatomic RV parameters should be systematically assessed when planning TMVR procedures for patients with severe SMR.
Authors: Michael I Brener; Amirali Masoumi; Vivian G Ng; Khodr Tello; Marcelo B Bastos; William K Cornwell; Steven Hsu; Ryan J Tedford; Philipp Lurz; Karl-Philipp Rommel; Karl-Patrik Kresoja; Sherif F Nagueh; Manreet K Kanwar; Navin K Kapur; Gurumurthy Hiremath; Mohammad Sarraf; Antoon J M Van Den Enden; Nicolas M Van Mieghem; Paul M Heerdt; Rebecca T Hahn; Susheel K Kodali; Gabriel T Sayer; Nir Uriel; Daniel Burkhoff Journal: Circ Heart Fail Date: 2021-12-29 Impact factor: 8.790
Authors: Lukas Stolz; Mathias Orban; Daniel Braun; Philipp Doldi; Martin Orban; Konstantin Stark; Michael Mehr; Julius Steffen; Kornelia Löw; Christian Hagl; Steffen Massberg; Michael Näbauer; Jörg Hausleiter Journal: Clin Res Cardiol Date: 2021-11-16 Impact factor: 6.138