Tricuspid regurgitation improvement after TMVR occurred in 36.9% of patients and was associated with lower all-cause mortality or heart failure hospitalization (HR 0.59).
Does tricuspid regurgitation improvement after transcatheter mitral valve replacement reduce mortality and heart failure hospitalization in patients with symptomatic mitral regurgitation?
In patients undergoing transcatheter mitral valve replacement, improvement in concomitant tricuspid regurgitation is an independent predictor of lower mortality and heart failure hospitalization at 2 years.
Absolute Event Rate: 0% vs 0%
Abstract Background Tricuspid regurgitation (TR) is a common bystander in patients with severe mitral regurgitation (MR). Transcatheter mitral valve replacement (TMVR) using dedicated devices offers an alternative treatment for high-risk MR patients and may also affect TR severity by effectively eliminating MR. Objectives This study aimed to assess incidence and prognostic value of TR improvement after TMVR using data from an international multicenter registry. Methods The CHOICE-MI registry included patients with symptomatic MR treated with dedicated TMVR devices at 31 international centers. This analysis included patients with TR ≥2+ at baseline and available post-procedural echocardiographic data. TR improvement was defined as a reduction of ≥1 grade at discharge compared to baseline. Residual MR and NYHA class were compared between patients with and without TR improvement. Kaplan-Meier estimates were calculated for the combined endpoints of all-cause mortality or heart failure (HF) hospitalization, and cardiovascular (CV) mortality or HF hospitalization after 2 years. Stepwise adjusted Cox regression assessed the prognostic value of TR improvement. Independent predictors were identified via multivariable analysis using backward selection. Results A total of 255 patients undergoing TMVR (age 76.0 years IQR 71.0-81.0, 58.4% male, EuroSCORE II 6.2% 3.6, 12.1) were included. Baseline TR was mild in 36.5% (N=93), moderate in 43.1% (N=110), severe in 18.0% (N=46), massive in 2.0% (N=5) and torrential in 0.4% (N=1). After TMVR, 94 patients (36.9%) showed TR improvement, while 161 patients (63.1%) did not. Patients with TR improvement were younger (75.0 years IQR 69.9-79.1 vs. 78.0 years IQR 73.0-82.0, p=0.0043) and had lower TAPSE (15.0mm IQR 12.0-19.8 vs. 17.0mm IQR 14.0-20.0, p=0.015). At discharge, MR was eliminated in most patients regardless of TR improvement (89.4% vs. 86.1%, p=0.57). At 1-year follow-up, the rate of patients at NYHA class I was higher in patients with TR improvement (41.4% vs. 24.1%, p=0.048). At 2 years, patients with TR improvement had lower rates of all-cause mortality/HF hospitalization (36.6% vs. 52.5%, p=0.067) and CV mortality/HF hospitalization (24.8% vs. 44.6%, p=0.039). Following stepwise Cox regression, TR improvement was independently associated with lower all-cause mortality/HF hospitalization (HR 0.59, 95%-CI 0.36-0.97, p=0.039) and CV mortality/HF hospitalization (HR 0.55, 95%-CI 0.31-0.99, p=0.046). In multivariable analysis, coronary artery disease (HR 0.52, 95%-CI 0.29-0.92, p=0.026) and TAPSE (HR 0.94, 95%-CI 0.88-0.99, p=0.019) were inversely predictive of TR improvement. Conclusions In this large real-world registry, TR improvement was found in over one-third of MR patients undergoing TMVR. It was an independent predictor of lower mortality and HF hospitalization and was associated with superior symptomatic benefit. These results support the need for echocardiographic follow-up of TR after TMVR.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.
Heide et al. (Sun,) reported a other. Tricuspid regurgitation improvement after TMVR occurred in 36.9% of patients and was associated with lower all-cause mortality or heart failure hospitalization (HR 0.59).