Predictors and Prognostic Relevance of Tricuspid Alterations in Patients Undergoing Transcatheter Edge-to-edge Mitral Valve Repair

Overview

Journal EuroIntervention

Specialties Cardiology & Vascular Diseases
Pharmacology

Date 2021 Mar 1

PMID 33646125

Citations 15

Authors

Refik Kavsur

Christos Iliadis

Maximilian Spieker

Birthe M Brachtendorf

Vedat Tiyerili

Clemens Metze

Patrick Horn

Stephan Baldus

Malte Kelm

Georg Nickenig

Roman Pfister

Ralf Westenfeld

Marc Ulrich Becher

Affiliations

Soon will be listed here.

Abstract

Background: Mitral valve repair may lead to alterations of tricuspid regurgitation (TR).

Aims: We aimed to investigate alterations, predictors and prognostic relevance of TR evolution in a large-scale multicentre population of patients undergoing transcatheter mitral valve repair (TMVR) via the MitraClip.

Methods: In total, we included 531 TMVR patients with at least one available follow-up echocardiography. TR improvement was defined as a TR ≥II at baseline, which showed a decline of at least one TR categorisation.

Results: Distribution of preprocedural TR severity was TR 0/I 41% (220/531), TR II 39% (209/531) and TR ≥III 19% (102/531), respectively. Follow-up echocardiography was at 308±187 days. TR severity improved to TR 0/I 49% (259/531), TR II 35% (183/531) and TR III 17% (89/531), p=0.003. Out of 311 patients with TR ≥II at baseline, 41% (127/311) showed TR improvement. Atrial fibrillation (AF), residual mitral regurgitation ≥II (rMR) and tricuspid annular diameter (TAD) remained variables which prevented TR improvement (odds ratio 0.49 [0.29-0.84], 0.47 [0.27-0.81] and 0.97 [0.93-0.997], respectively). TR improvement was associated with better event-free survival regarding post-procedural heart failure hospitalisation (HHF) (hazard ratio 0.6 [0.38-0.94]). The main changes of TR severity occurred within 3 months post TMVR (p=0.006), while there were only minor TR changes between 3 and 12 months of follow-up (p=0.813).

Conclusions: TR improvement was frequent after TMVR. Predictors preventing TR improvement were AF, post-procedural rMR, and TAD. Furthermore, TR improvement was an early phenomenon occurring primarily within the first three months post TMVR and served as a suitable marker of reduced HHF.

Citing Articles

Prediction of tricuspid regurgitation regression after mitral valve transcatheter edge-to-edge repair using three-dimensional transoesophageal echocardiography.

Takeuchi M, Utsunomiya H, Tohgi K, Hamada A, Hyodo Y, Tsuchiya A Eur Heart J Imaging Methods Pract. 2025; 3(1):qyaf016.

PMID: 39935630 PMC: 11811635. DOI: 10.1093/ehjimp/qyaf016.

Insulin-Like Growth Factor Binding Protein 2 Predicts Right Ventricular Reverse Remodeling and Improvement of Concomitant Tricuspid Regurgitation After Transcatheter Edge-to-Edge Mitral Valve Repair.

Groger M, Felbel D, Paukovitsch M, Schneider L, Markovic S, Rottbauer W Clin Cardiol. 2024; 47(12):e70048.

PMID: 39600082 PMC: 11599423. DOI: 10.1002/clc.70048.

Implications of Tricuspid Regurgitation Severity in Patients Undergoing Mitral Transcatheter Edge-to-Edge Repair.

Shechter A, Taheri H, Nagasaka T, Gupta A, Kaewkes D, Patel V J Am Heart Assoc. 2024; 13(23):e037635.

PMID: 39575719 PMC: 11681571. DOI: 10.1161/JAHA.124.037635.

Predictors of Residual Severe Tricuspid Regurgitation After Transcatheter Mitral Valve Repair.

Basman C, Kodra A, Pirelli L, Mustafa A, Mehla P, Trost B J Soc Cardiovasc Angiogr Interv. 2024; 2(4):100612.

PMID: 39131656 PMC: 11307626. DOI: 10.1016/j.jscai.2023.100612.

Time to Redefine Optimal Medical Therapy With Contemporary Therapies for Secondary Tricuspid Valve Regurgitation.

Vazir A JACC Case Rep. 2023; 25:102059.

PMID: 38094207 PMC: 10715924. DOI: 10.1016/j.jaccas.2023.102059.

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