Mitral regurgitation (MR) is a common valvular disease associated with poor prognosis. Percutaneous mitral valve repair (PMVR) combined with guideline-directed medical therapy has shown prognostic bene ts, yet a substantial proportion of patients experience major adverse cardiovascular events (MACE), including death and heart failure hospitalization, within the rst year. Identifying short-term nonresponders remains a clini- cal priority. This study evaluated the prognostic value of advanced right ventricular (RV) function parameters in predicting MACE following PMVR using the MitraClip system. A total of 60 consecutive patients with symptomatic severe MR undergoing PMVR were analyzed. Echocardiographic assessments were performed at baseline, postprocedure before discharge, and at 6-month follow-up. Parameters included tricuspid annu- lar plane systolic excursion (TAPSE) normalized to pulmonary artery systolic pressure (TAPSE/PASP), right ventricular end-diastolic area (TAPSE/RVAD), and end-systolic area (TAPSE/RVAS), along with RV myocardial work indices. During the rst year, 35% of patients experienced MACE. At baseline, those who developed MACE had signi cantly higher creatinine, troponin T, NT-proBNP levels, larger right heart dimensions, and lower TAPSE (all p <0.05), while other clinical, imaging, and procedural characteristics were similar. In multi- variate analysis, TAPSE/PASP, TAPSE/RVAS, and TAPSE/RVAD were independent predictors of MACE (all p <0.05), with AUC values ranging from 0.80 to 0.85, indicating strong predictive capacity. Throughout fol- low-up, these indices remained signi cantly lower in patients with MACE, while RV myocardial work param- eters had lower predictive accuracy (AUC<0.60). In conclusion, a comprehensive RV assessment, particularly TAPSE-based indices, can help identify patients at higher risk of adverse outcomes after PMVR, whereas RV myocardial work indices appear less reliable.
Novel Right ventricular function parameters can identify short-term non-responders to transcatheter edge-to-edge repair for mitral regurgitation / Mistrulli, Raffaella; Storozhenko, Tatyana; Iturriagagoitia, Arthur; Corradetti, Sara; Mattia Viscusi, Michele; Buytaert, Dimitri; Mahendiran, Thabo; K De Oliveira, Elayne; Addeo, Lucio; Barbato, Emanuele; Spapen, Jerrold; Bartunek, Jozef; Vanderheyden, Marc; Van Camp, Guy; Penicka, Martin. - In: THE AMERICAN JOURNAL OF CARDIOLOGY. - ISSN 0002-9149. - (2025). [10.1016/j.amjcard.2025.03.034]
Novel Right ventricular function parameters can identify short-term non-responders to transcatheter edge-to-edge repair for mitral regurgitation
Raffaella Mistrulli;Sara Corradetti;Emanuele Barbato;
2025
Abstract
Mitral regurgitation (MR) is a common valvular disease associated with poor prognosis. Percutaneous mitral valve repair (PMVR) combined with guideline-directed medical therapy has shown prognostic bene ts, yet a substantial proportion of patients experience major adverse cardiovascular events (MACE), including death and heart failure hospitalization, within the rst year. Identifying short-term nonresponders remains a clini- cal priority. This study evaluated the prognostic value of advanced right ventricular (RV) function parameters in predicting MACE following PMVR using the MitraClip system. A total of 60 consecutive patients with symptomatic severe MR undergoing PMVR were analyzed. Echocardiographic assessments were performed at baseline, postprocedure before discharge, and at 6-month follow-up. Parameters included tricuspid annu- lar plane systolic excursion (TAPSE) normalized to pulmonary artery systolic pressure (TAPSE/PASP), right ventricular end-diastolic area (TAPSE/RVAD), and end-systolic area (TAPSE/RVAS), along with RV myocardial work indices. During the rst year, 35% of patients experienced MACE. At baseline, those who developed MACE had signi cantly higher creatinine, troponin T, NT-proBNP levels, larger right heart dimensions, and lower TAPSE (all p <0.05), while other clinical, imaging, and procedural characteristics were similar. In multi- variate analysis, TAPSE/PASP, TAPSE/RVAS, and TAPSE/RVAD were independent predictors of MACE (all p <0.05), with AUC values ranging from 0.80 to 0.85, indicating strong predictive capacity. Throughout fol- low-up, these indices remained signi cantly lower in patients with MACE, while RV myocardial work param- eters had lower predictive accuracy (AUC<0.60). In conclusion, a comprehensive RV assessment, particularly TAPSE-based indices, can help identify patients at higher risk of adverse outcomes after PMVR, whereas RV myocardial work indices appear less reliable.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
