| Přispěvatelé: |
Adamo, Marianna, Inciardi, Riccardo Maria, Tomasoni, Daniela, Dallapellegrina, Lucia, Estévez-Loureiro, Rodrigo, Stolfo, Davide, Lupi, Laura, Pancaldi, Edoardo, Popolo Rubbio, Antonio, Giannini, Cristina, Benito-González, Tomá, Fernández-Vázquez, Felipe, Caneiro-Queija, Berenice, Godino, Cosmo, Munafò, Andrea, Pascual, Isaac, Avanzas, Pablo, Frea, Simone, Boretto, Paolo, Moñivas Palomero, Vanessa, Del Trigo, Maria, Biagini, Elena, Berardini, Alessandra, Nombela-Franco, Lui, Jimenez-Quevedo, Pilar, Lipsic, Erik, Saia, Francesco, Petronio, Anna Sonia, Bedogni, Francesco, Sinagra, Gianfranco, Guazzi, Marco, Voors, Adriaan, Metra, Marco, Cardiovascular Centre (CVC) |
| Popis: |
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 (M-TEER). 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 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). 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. |
