Key result
A discontinuous intrarenal venous flow pattern was independently associated with a significantly increased risk of all-cause death and heart failure rehospitalization (HR 3.240) after mitral transcatheter edge-to-edge repair.
Why the study?
The prognostic implications of renal congestion assessed by intrarenal Doppler ultrasonography after mitral transcatheter edge-to-edge repair were unknown.
Does a discontinuous intrarenal venous flow pattern predict the composite outcome of all-cause death and heart failure rehospitalization in patients with secondary mitral regurgitation undergoing mitral TEER?
Cohort (n=105)
No
Does a discontinuous intrarenal venous flow pattern predict the composite outcome of all-cause death and heart failure rehospitalization in patients with secondary mitral regurgitation undergoing mitral TEER?
Hazard Ratio: 3.24 (95% CI 1.3–8.076)
p-value: p=0.012
A discontinuous intrarenal venous flow pattern assessed by Doppler ultrasonography is a strong independent predictor of death and heart failure rehospitalization in patients with secondary mitral regurgitation undergoing TEER.
Renal congestion by IRD may stratify post-TEER risk; leaves open whether it should guide selection or management.
BACKGROUND: Renal congestion is a potential prognostic factor in patients with heart failure and recently, assessment has become possible with intrarenal Doppler ultrasonography (IRD). The association between renal congestion assessed by IRD and outcomes after mitral transcatheter edge-to-edge repair (TEER) is unknown, so we aimed to clarify renal congestion and its prognostic implications in patients with mitral regurgitation (MR) who underwent TEER using MitraClip system. METHODS AND RESULTS: Patients with secondary MR who underwent TEER and were assessed for intrarenal venous flow (IRVF) by IRD were classified according to their IRVF pattern as continuous or discontinuous. Of the 105 patients included, 78 patients (74%) formed the continuous group and 27 (26%) were the discontinuous group. Kaplan-Meier analysis revealed significant prognostic power of the IRVF pattern for predicting the composite outcome of all-cause death and heart failure rehospitalization (log-rank P=0.0257). On multivariate Cox regression analysis, the composite endpoint was independently associated with the discontinuous IRVF pattern (hazard ratio, 3.240; 95% confidence interval, 1.300-8.076; P=0.012) adjusted using inverse probability of treatment weighting. CONCLUSIONS: IRVF patterns strongly correlated with clinical outcomes without changes in renal function. Thus, they may be useful for risk stratification after mitral TEER for patients with secondary MR.
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Kuwata et al. (2023) conducted a cohort in Secondary mitral regurgitation (n=105). Discontinuous intrarenal venous flow (IRVF) pattern vs. Continuous intrarenal venous flow (IRVF) pattern was evaluated on Composite of all-cause death or heart failure rehospitalization (HR 3.240, 95% CI 1.300-8.076, p=0.012). A discontinuous intrarenal venous flow pattern was independently associated with a significantly increased risk of all-cause death and heart failure rehospitalization (HR 3.240) after mitral transcatheter edge-to-edge repair.
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