Concomitant pulmonary hypertension (HR 1.70; 95% CI 1.00-2.87), RV dysfunction (HR 1.86; 95% CI 1.45-2.38), and tricuspid regurgitation (HR 1.51; 95% CI 1.28-1.79) increased mortality after TMVR.
Meta-Analysis (n=8,672)
Does the presence of pulmonary hypertension, right ventricular dysfunction, or tricuspid regurgitation worsen all-cause mortality in patients undergoing transcatheter mitral valve repair?
Concomitant pulmonary hypertension, right ventricular dysfunction, and tricuspid regurgitation are significantly associated with increased all-cause mortality after transcatheter mitral valve repair.
Hazard Ratio: 1.7 (95% CI 1–2.87)
BACKGROUND: Pulmonary hypertension (PH), right ventricular (RV) dysfunction, and tricuspid regurgitation (TR) are commonly present in patients with mitral regurgitation (MR) and known to impair prognosis. This systematic review and meta-analysis aimed to determine the prognostic value of PH, RV function, and TR on mortality after transcatheter mitral valve repair (TMVR). METHODS: A systematic search was performed to identify studies investigating PH, RV function, or TR in patients who underwent TMVR. Studies were included for pooled analysis if hazard ratios (HR) for all-cause mortality were given. RESULTS: A total of 8,672 patients from 21 selected studies were included (PH, 11 studies; RV function, nine studies; TR, 10 studies). Mean follow-up was 2.7±1.6 years. The HRs and 95% CIs for all-cause mortality of PH (dichotomised: HR 1.70, 95% CI 1.00-2.87; per 10 mmHg increase in systolic PAP: HR 1.17, 95% CI 1.07-1.29), RV function (dichotomised: HR 1.86, 95% CI 1.45-2.38; per 5 mm decrease in TAPSE: HR 1.18, 95% CI 0.97-1.43) and TR (HR 1.51, 95% CI 1.28-1.79) indicated a significant association. CONCLUSION: Prognosis after TMVR is worse in patients with significant MR when concomitant PH, RV dysfunction, or TR are present. Careful assessment of these parameters should therefore precede clinical decision-making for TMVR. The current results encourage investigation into whether (1) intervention at an earlier stage of MR reduces incidence of PH, RV dysfunction, and TR; and (2) transcatheter treatment of concomitant TR can improve clinical outcome and prognosis for these patients.
Meijerink et al. (Mon,) conducted a meta-analysis in Mitral regurgitation undergoing transcatheter mitral valve repair (n=8,672). Pulmonary hypertension, right ventricular dysfunction, and tricuspid regurgitation vs. Absence or lower severity of these conditions was evaluated on All-cause mortality (HR 1.70, 95% CI 1.00-2.87). Concomitant pulmonary hypertension (HR 1.70; 95% CI 1.00-2.87), RV dysfunction (HR 1.86; 95% CI 1.45-2.38), and tricuspid regurgitation (HR 1.51; 95% CI 1.28-1.79) increased mortality after TMVR.
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