Changes in Right Ventricular–to–Pulmonary Artery Coupling After Transcatheter Edge-to-Edge Repair in Secondary Mitral Regurgitation

医学 心脏病学 内科学 二尖瓣反流 肺动脉 射血分数 心力衰竭 肺动脉高压 回顾性队列研究 反流(循环)
作者
Marianna Adamo,Riccardo M. Inciardi,Daniela Tomasoni,Lucia Dallapellegrina,Rodrigo Estévez‐Loureiro,Davide Stolfo,L Lupi,Edoardo Pancaldi,Antonio Popolo Rubbio,Cristina Giannini,Tomas Benito‐González,Felipe Fernández‐Vázquez,Berenice Caneiro‐Queija,Cosmo Godino,Andrea Munafò,Isaac Pascual,Pablo Avanzas,Simone Frea,Paolo Boretto,Vanessa Moñivas Palomero
出处
期刊:Jacc-cardiovascular Imaging [Elsevier BV]
卷期号:15 (12): 2038-2047 被引量:30
标识
DOI:10.1016/j.jcmg.2022.08.012
摘要

Preprocedural right ventricular–to–pulmonary artery (RV-PA) coupling is a major predictor of outcome in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (M-TEER). However, clinical significance of changes in RV-PA coupling after M-TEER is unknown. The aim of this study was to evaluate changes in RV-PA coupling after M-TEER, their prognostic value, and predictors of improvement. This was a retrospective observational study, including patients undergoing successful M-TEER (residual mitral regurgitation ≤2+ at discharge) for SMR at 13 European centers and with complete echocardiographic data at baseline and short-term follow-up (30-180 days). RV-PA coupling was assessed with the use of echocardiography as the ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP). All-cause death was assessed at the longest available follow-up starting from the time of the echocardiographic reassessment. Among 501 patients included, 331 (66%) improved their TAPSE/PASP after M-TEER (responders) at short-term follow-up (median: 89 days; IQR: 43-159 days), whereas 170 (34%) did not (nonresponders). Lack of previous cardiac surgery, low postprocedural mitral mean gradient, low baseline TAPSE, high baseline PASP, and baseline tricuspid regurgitation were independently associated with TAPSE/PASP improvement after M-TEER. Compared with nonresponders, responders had lower New York Heart Association functional class and less heart failure hospitalizations at short-term follow-up. Improvement in TAPSE/PASP was independently associated with reduced risk of mortality at long-term follow-up (584 days; IQR: 191-1,243 days) (HR: 0.65 [95% CI: 0.42-0.92]; P = 0.017). In patients with SMR, improvement in TAPSE/PASP after successful M-TEER is predicted by baseline clinical and echocardiographic variables and postprocedural mitral gradient, and is associated with a better outcome.
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