Key result
Preprocedural functional TR linked to ~77% higher 1-year cardiac mortality after MitraClip in HFrEF.
Why the study?
The impact of preinterventional moderate-to-severe functional tricuspid regurgitation on early outcome after MitraClip therapy in patients with HFrEF and functional mitral regurgitation was unclear.
Cohort (n=80)
No
Hazard Ratio: 1.77 (95% CI 1.01–3.09)
Absolute Event Rate: 36% vs 17%
p-value: p=0.047
Moderate-to-severe baseline TR signals higher 1-year cardiac mortality after MitraClip in HFrEF; leaves open whether tricuspid intervention improves survival.
Aim: To evaluate the impact of preinterventional moderate-to-severe functional tricuspid regurgitation (FTR) on early outcome after percutaneous edge-to-edge mitral valve repair (pMVR) with MitraClip procedures for functional mitral regurgitation (FMR) in patients with heart failure with reduced ejection fraction (HFrEF). Methods and results: From January 2013 to December 2017, 80 patients with HFrEF (ejection fraction 22%±5.3%) and FMR (grade 3.0±0.36) underwent successful pMVR. The 3-year actuarial survival was 58%. However, 73% (n=22) of non-survivors died of cardiac failure within 1 year. Patients were categorised into none-to-mild (n=36) and moderate-to-severe (n=44) postinterventional FTR groups according to pre-MitraClip tricuspid regurgitation grade. Cox regression analysis on 1-year survival demonstrated an impact of FTR severity (HR=1.8, 95% CI 1.01% to 3.09%, p=0.047), preoperative New York Heart Association class (HR=2.8, 95% CI 1.2% to 6.5%, p=0.015) and peripheral artery disease (HR=5.4, 95% CI 1.6 to 18, p=0.0054). Kaplan-Meier analysis showed that 1-year cardiac death was higher in the moderate-to-severe FTR group (p=0.048). In our study, 77% of pre-MitraClip moderate-to-severe FTR cannot be significantly reduced. Post-MitraClip moderate-to-severe FTR grade was related to lower survival (p<0.001). Conclusion: In patients with HFrEF treated with MitraClip for FMR, moderate-to-severe FTR was an independent predictor of cardiac death within 1 year. To improve survival, additional therapy to residual FTR should be considered in early phase after MitraClip therapy.
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Gyoten et al. (2020) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) and functional mitral regurgitation (FMR) (n=80). Moderate-to-severe functional tricuspid regurgitation (FTR) vs. None-to-mild FTR was evaluated on Cardiac death at 1-year follow-up (HR 1.77, 95% CI 1.01-3.09, p=0.047). Preprocedural moderate-to-severe functional tricuspid regurgitation was an independent predictor of cardiac death within 1 year (HR 1.77) in patients with HFrEF treated with MitraClip.
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