Key result
The presence of pulmonary hypertension was associated with significantly higher all-cause mortality (HR 1.70) following transcatheter mitral valve repair, as were right ventricular dysfunction and tricuspid regurgitation.
Why the study?
Pulmonary hypertension, RV dysfunction, and TR commonly affect patients with MR and impair prognosis, but their prognostic impact on mortality following TMVR required determination.
Does the presence of pulmonary hypertension, right ventricular dysfunction, or tricuspid regurgitation increase all-cause mortality in patients undergoing transcatheter mitral valve repair?
Meta-Analysis (n=8,672)
Yes
Does the presence of pulmonary hypertension, right ventricular dysfunction, or tricuspid regurgitation increase all-cause mortality in patients undergoing transcatheter mitral valve repair?
Hazard Ratio: 1.7 (95% CI 1–2.87)
Concomitant right-sided heart disease parameters (pulmonary hypertension, RV dysfunction, tricuspid regurgitation) significantly impair survival following transcatheter mitral valve repair, reinforcing the need for comprehensive baseline echocardiographic assessment.
Supports pre-TMVR right-heart assessment for risk stratification; extends observational evidence on PH, RV dysfunction, and TR as mortality markers.
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.
No takes yet. Share an insight, caveat, or question.
Meijerink et al. (2022) conducted a meta-analysis in Mitral regurgitation treated with transcatheter mitral valve repair (TMVR) (n=8,672). Pulmonary hypertension (systolic PAP >50 mmHg) vs. Absence of pulmonary hypertension (systolic PAP <=50 mmHg) was evaluated on All-cause mortality (HR 1.70, 95% CI 1.00-2.87). The presence of pulmonary hypertension was associated with significantly higher all-cause mortality (HR 1.70) following transcatheter mitral valve repair, as were right ventricular dysfunction and tricuspid regurgitation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: