Early response of right-ventricular function to percutaneous mitral valve repair,Clinical Research in Cardiology

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Early response of right-ventricular function to percutaneous mitral valve repair
Clinical Research in Cardiology ( IF 3.8 ) Pub Date : 2021-10-20 , DOI: 10.1007/s00392-021-01951-7
Atsushi Sugiura ₁ , Jasmin Shamekhi ₁ , Tadahiro Goto ₂ , Maximilian Spieker ₃ , Christos Iliadis ₄ , Refik Kavsur ₁ , Victor Mauri ₄ , Malte Kelm ₃ , Stephan Baldus ₄ , Tetsu Tanaka ₁ , Noriaki Tabata ₅ , Jan-Malte Sinning ₆ , Marcel Weber ₁ , Sebastian Zimmer ₁ , Georg Nickenig ₁ , Ralf Westenfeld ₃ , Roman Pfister ₄ , Marc Ulrich Becher ₁ ,

Affiliation

Background

The change in right-ventricular function (RVF) after transcatheter mitral valve repair is still poorly understood. We assessed the early response of RVF to the MitraClip procedure and its clinical relevance.

Methods

We analyzed consecutive patients who underwent a MitraClip procedure to treat MR between August 2010 and March 2019 in the Heart Failure Network Rhineland registry. RVF was assessed before and after the procedure. Impaired RVF was defined as an RV fractional area change (RVFAC) < 35% or tricuspid annular plane systolic excursion (TAPSE) < 16 mm.

Results

816 eligible patients (77 ± 9 years, 58.5% male) were included in the analysis. Baseline values of RVF were: RVFAC 38.6 (IQR 29.7–46.7) % and TAPSE 17.0 (IQR 14.0–21.0) mm. At a median time of 3 (IQR 2–5) days after the procedure, the RVF remained normal in 34% (n = 274), normalized in 17% (n = 140), deteriorated in 15% (n = 125), and was persistently impaired in 34% (n = 277) of patients. The RVF response was significantly associated with a composite outcome of all-cause mortality and hospitalization due to heart failure within a 2-year follow-up. Compared to stable/normal RVF, the adjusted hazard ratios for the outcome were 1.78 (95% CI 1.10–2.86) for normalized RVF, 1.89 (95% CI 1.34–3.15) for deteriorated RVF, and 2.25 (95% CI 1.47–3.44) for persistently impaired RVF. Changes in TAPSE and RVFAC as continuous variables were significantly correlated with the outcome.

Conclusion

An early change in RVF following transcatheter mitral valve repair is predictive of mortality and hospitalization due to heart failure during follow-up.

Graphic abstract

Early response of RVF after MitraClip and its clinical significance. An acute, early change in RVF can be observed following the MitraClip procedure, which is associated with the risk of mortality and hospitalization for HF.

中文翻译：

右心室功能对经皮二尖瓣修复术的早期反应

背景

经导管二尖瓣修复后右心室功能 (RVF) 的变化仍知之甚少。我们评估了裂谷热对 MitraClip 手术的早期反应及其临床相关性。

方法

我们分析了 2010 年 8 月至 2019 年 3 月期间在心力衰竭网络莱茵兰登记处接受 MitraClip 手术治疗 MR 的连续患者。在手术前后评估 RVF。RVF 受损定义为 RV 面积变化 (RVFAC) < 35% 或三尖瓣环平面收缩偏移 (TAPSE) < 16 mm。

结果

816 名符合条件的患者（77 ± 9 岁，58.5% 男性）被纳入分析。RVF 的基线值为： RVFAC 38.6 (IQR 29.7–46.7) % 和 TAPSE 17.0 (IQR 14.0–21.0) mm。在手术后 3 (IQR 2-5) 天的中位时间，34% ( n = 274) 的裂谷热保持正常，17% ( n = 140) 正常化，15% ( n = 125) 恶化，并且有 34% 的人持续受损（n = 277) 的患者。在 2 年的随访中，RVF 反应与全因死亡率和因心力衰竭住院的复合结果显着相关。与稳定/正常 RVF 相比，归一化 RVF 的结果调整后风险比为 1.78 (95% CI 1.10–2.86)，恶化 RVF 为 1.89 (95% CI 1.34–3.15) 和 2.25 (95% CI 1.47–3.44) ) 用于持续受损的裂谷热。TAPSE 和 RVFAC 作为连续变量的变化与结果显着相关。