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

Autor: Shechter A; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA.; Department of Cardiology Rabin Medical Center Petach Tikva Israel.; Faculty of Medicine Tel Aviv University Tel Aviv Israel., Taheri H; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA., Nagasaka T; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA.; Department of Cardiovascular Medicine Gunma University Graduate School of Medicine Maebashi Gunma Japan., Gupta A; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA., Kaewkes D; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA.; Department of Medicine, Faculty of Medicine Khon Kaen University Khon Kaen Thailand., Patel V; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA., Suruga K; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA., Dhillon M; Department of Medicine Cedars-Sinai Medical Center Los Angeles CA USA., Koseki K; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA.; Department of Cardiovascular Medicine The University of Tokyo Tokyo Japan., Koren O; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA., Makar M; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA., Skaf S; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA., Patel D; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA., Chakravarty T; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA., Siegel RJ; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA.; David Geffen School of Medicine University of California Los Angeles Los Angeles CA USA., Makkar RR; Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Dec 03; Vol. 13 (23), pp. e037635. Date of Electronic Publication: 2024 Nov 22.
DOI: 10.1161/JAHA.124.037635
Abstrakt: Background: Prognostically meaningful tricuspid regurgitation (TR) is not well-defined in the mitral transcatheter edge-to-edge repair arena. We aimed to explore the prevalence, correlates, and consequences of TR grades and postprocedural trends in this setting.
Methods and Results: A single-center registry of isolated, first-time interventions was retrospectively assessed for pre-, intra-, and postprocedural aspects up to 1 year, of them the primary composite outcome of all-cause deaths or heart failure (HF) hospitalizations, all according to TR severity at baseline and at 1 month following mitral transcatheter edge-to-edge repair. Overall, 1287 individuals (60.3% men, age 78 [interquartile range, 69-85] years, 52.9% with functional mitral regurgitation) were included. Below-moderate, moderate, and above-moderate TR affected 48.4%, 29.5%, and 22.1% of patients, respectively. Increasing TR severity was accompanied by higher rates of functional, severe mitral regurgitation, greater comorbidity, and more advanced heart failure. Although not affecting technical and echocardiographic procedural success, moderate-and-above TR degrees were associated with higher incidence of mortality, heart failure admissions, and functional class III to IV postprocedure, with moderate-to-severe and greater TR independently conferring increased risk for the various outcomes (primary end point; HR, 1.36 [95% CI, 1.21-1.80]; P =0.027). One-month postprocedural TR severity directly correlated with, and was mostly similar to or worse than, its baseline counterpart. Rather than the change between the two, moderate-and-above grade at 1 month, observed in 37.1% of eligible cases, emerged as predictive of the primary outcome's risk.
Conclusions: Among patients undergoing mitral transcatheter edge-to-edge repair, above-moderate TR at baseline and the closely related moderate-and-above TR at 1 month postprocedure are highly prevalent and signal a suboptimal course.
Databáze: MEDLINE
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