Changes in Right Ventricular-to-Pulmonary Artery Coupling After Transcatheter Edge-to-Edge Repair in Secondary Mitral Regurgitation
Articolo
Data di Pubblicazione:
2022
Citazione:
Changes in Right Ventricular-to-Pulmonary Artery Coupling After Transcatheter Edge-to-Edge Repair in Secondary Mitral Regurgitation / M. Adamo, R.M. Inciardi, D. Tomasoni, L. Dallapellegrina, R. Estévez-Loureiro, D. Stolfo, L. Lupi, E. Pancaldi, A. Popolo Rubbio, C. Giannini, T. Benito-González, F. Fernández-Vázquez, B. Caneiro-Queija, C. Godino, A. Munafò, I. Pascual, P. Avanzas, S. Frea, P. Boretto, V. Moñivas Palomero, M. Del Trigo, E. Biagini, A. Berardini, L. Nombela-Franco, P. Jimenez-Quevedo, E. Lipsic, F. Saia, A.S. Petronio, F. Bedogni, G. Sinagra, M. Guazzi, A. Voors, M. Metra. - In: JACC. CARDIOVASCULAR INTERVENTIONS. - ISSN 1876-7591. - 15:12(2022 Dec), pp. 2038-2047. [10.1016/j.jcmg.2022.08.012]
Abstract:
BACKGROUND 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 (MTEER). However, clinical significance of changes in RV-PA coupling after M-TEER is unknown. OBJECTIVES The aim of this study was to evaluate changes in RV-PA coupling after M-TEER, their prognostic value, and predictors of improvement. METHODS 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. RESULTS Among 501 patients included, 331 (66%) improved their TAPSE/PASP after M-TEER (responders) at shortterm 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). CONCLUSIONS 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. (J Am Coll Cardiol Img 2022;15:2038-2047) (c) 2022 Published by Elsevier on behalf of the American College of Cardiology Foundation.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
right ventricular to pulmonary artery coupling; secondary mitral regurgitation; transcatheter edge-to-edge mitral valve repair
Elenco autori:
M. Adamo, R.M. Inciardi, D. Tomasoni, L. Dallapellegrina, R. Estévez-Loureiro, D. Stolfo, L. Lupi, E. Pancaldi, A. Popolo Rubbio, C. Giannini, T. Benito-González, F. Fernández-Vázquez, B. Caneiro-Queija, C. Godino, A. Munafò, I. Pascual, P. Avanzas, S. Frea, P. Boretto, V. Moñivas Palomero, M. Del Trigo, E. Biagini, A. Berardini, L. Nombela-Franco, P. Jimenez-Quevedo, E. Lipsic, F. Saia, A.S. Petronio, F. Bedogni, G. Sinagra, M. Guazzi, A. Voors, M. Metra
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