Karam, Nicole ORCID: 0000-0002-3861-6914, Stolz, Lukas, Orban, Mathias, Deseive, Simon, Praz, Fabien ORCID: 0000-0001-5416-165X, Kalbacher, Daniel, Westermann, Dirk, Braun, Daniel, Nabauer, Michael, Neuss, Michael, Butter, Christian, Kassar, Mohammad, Petrescu, Aniela, Pfister, Roman, Iliadis, Christos, Unterhuber, Matthias ORCID: 0000-0002-8175-276X, Park, Sang-Don, Thiele, Holger, Baldus, Stephan, von Bardeleben, Ralph Stephan ORCID: 0000-0002-1356-0037, Blankenberg, Stefan, Massberg, Steffen, Windecker, Stephan, Lurz, Philipp and Hausleiter, Joerg (2021). Impact of Right Ventricular Dysfunction on Outcomes After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation. JACC-Cardiovasc. Imag., 14 (4). S. 758 - 769. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1876-7591

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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. (C) 2021 Published by Elsevier on behalf of the American College of Cardiology Foundation.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Karam, NicoleUNSPECIFIEDorcid.org/0000-0002-3861-6914UNSPECIFIED
Stolz, LukasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Orban, MathiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Deseive, SimonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Praz, FabienUNSPECIFIEDorcid.org/0000-0001-5416-165XUNSPECIFIED
Kalbacher, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Westermann, DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Braun, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nabauer, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neuss, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Butter, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kassar, MohammadUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Petrescu, AnielaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pfister, RomanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Iliadis, ChristosUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Unterhuber, MatthiasUNSPECIFIEDorcid.org/0000-0002-8175-276XUNSPECIFIED
Park, Sang-DonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thiele, HolgerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baldus, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
von Bardeleben, Ralph StephanUNSPECIFIEDorcid.org/0000-0002-1356-0037UNSPECIFIED
Blankenberg, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Massberg, SteffenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Windecker, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lurz, PhilippUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hausleiter, JoergUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-601938
DOI: 10.1016/j.jcmg.2020.12.015
Journal or Publication Title: JACC-Cardiovasc. Imag.
Volume: 14
Number: 4
Page Range: S. 758 - 769
Date: 2021
Publisher: ELSEVIER SCIENCE INC
Place of Publication: NEW YORK
ISSN: 1876-7591
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
NATIVE VALVULAR REGURGITATION; EUROPEAN-ASSOCIATION; HEART-FAILURE; VALVE REPAIR; TRICUSPID REGURGITATION; AMERICAN-SOCIETY; ECHOCARDIOGRAPHIC-ASSESSMENT; CHAMBER QUANTIFICATION; PULMONARY-HYPERTENSION; CONSERVATIVE TREATMENTMultiple languages
Cardiac & Cardiovascular Systems; Radiology, Nuclear Medicine & Medical ImagingMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/60193

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